MOHS SURGERY CONFIRMATION NOTICE Date:______Dear: ______

To follow-up our conversation regarding the results of your recent skin biopsy, your physician has recommended MOHS Surgery as treatment of your skin cancer. This treatment for skin cancer will be performed in our office by Dr. Andrew J. West.

You will find information enclosed that will explain this surgery in more detail. At this time, I would like to review a few pre-operative instructions:

1. COMPLETELY AVOID ASPIRIN, Ticlid, Plavix, Coumadin, Ibuprofen, or Vitamin E. These are all medications which may cause excess bleeding. Do not discontinue these medications without the approval of the prescribing physician. 2. Maintain your normal intake of food and liquids. This procedure is performed under local anesthetic; therefore, it is not necessary for you to restrict your diet prior to surgery. In fact, it is recommended that you have a balanced meal before arriving for your surgery. 3. It is recommended that you avoid alcohol and tobacco products for one week prior to surgery as these may hinder the healing process. 4. Plan to shower and wash your hair the night before surgery. You may not be able to shower for 24 to 48 hours after surgery. 5. Wear comfortable clothes that do not have to be pulled over your head after the surgery. 6. We ask that you bring someone with you to be with you and take you home after the surgery. 7. This type of surgery is a staged process so please be prepared to remain at our office for much of the day. You may wish to bring reading materials to help pass the time during the necessary waiting period. There is a deli located within the building, if you are here during lunch hour.

Your surgery is scheduled on ______(date) at ______(time). Please check in at entrance A, Patient Registration. Please arrive 10 minutes prior to your appointment to complete the necessary pre-operative documentation and surgery care.

If your insurance requires a referral for this surgery, please contact your Primary Care Physician immediately to obtain your referral. Referrals must be obtained prior to surgery to ensure coverage of this procedure. For Insurance/Billing/Referral questions please call our Billing Department at 502 897-3366.

If you have any further questions please contact our Patient Care Coordinator at 502 896-6355 between 8:30 AM and 5:00 PM, Monday through Friday.

Sincerely,

Patient Care Coordinator Dermatology Associates, PSC