Many dentists, optometrists and other specialty providers are sending adult patients to our primary-care clinic for surgical or procedural clearance. Are there standards of practice for such patients? — Debra C. Allen, MSN, ANP/GNP, Reidsville, N.C.

There are no clinical guidelines for surgical clearance by the primary-care provider. Many specialists request that the patient be evaluated prior to a procedure — especially those over age 50 years and/or those with chronic medical problems — to determine the risk of complication during and immediately after the procedure. The evaluation should include an assessment of the status of the medical problems and any special instructions related to the dosing of medications leading up to or on the day of the procedure. — Eileen F. Campbell, MSN, CRNP (155-12)