Medical clearance from the primary care physician

How do we get the medical clearance for surgery from the patient's primary care physician, with the letter and the results chased, checked and filed before the surgery date?

Send the clearance request to the right physician with what the surgeon needs, and chase it against the date. When a surgery needs clearance, Callvu identifies the primary care physician or the specialist from the EHR and the patient, sends the request through the physician's channel with the procedure, the date, the anesthesia plan and the specific items the surgical and anesthesia policies require for this patient (the examination, the medication management including anticoagulants, the tests by risk category, the condition-specific opinions), chases the office on a clock set from the surgery date, reads the letter and the results on arrival and checks them against the request (the patient, the dates, the items answered, the restrictions stated), routes a clearance with conditions, a refusal or a missing item to the surgical team in the Decision Desk, and files the clearance to the EHR against the case with the day-of-surgery checklist updated.

In scopeComplex: multi-party handoffsCallvu moves: chase and verify, decide, write back

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Last updated November 7, 2026.

The problem today

The clearance letter arrived the afternoon before surgery and said the patient should stop a blood thinner they had taken that morning.

Today, without Callvu

Surgery needs the primary care physician's clearance. The surgeon's office faxes a request; the physician's office schedules the patient when it can; the letter arrives late, generic, without the medication instructions or the test the anesthesia policy required, or with a condition nobody reads. The case is cancelled on the morning, or worse, proceeds.

A clearance is a specific request: the procedure and the date, the anesthesia plan, the risk category and the tests it requires, the medications to manage (the anticoagulant and the antiplatelet plans, the diabetes and the blood pressure medications), the conditions that need a specialist's opinion. The physician's office holds the patient's history; HIPAA permits the exchange for treatment; the surgical and anesthesia standards set what the clearance must cover. The surgery date is the deadline.

A specific request chased against the date returns a clearance the team can act on.

How it runs

From the requestto the system of record.

A surgery is booked and the surgical or anesthesia policy requires a medical clearance for the patient's risk category. Callvu opens the clearance from the case.

Primary care physician or specialist: Receives the request through their channel, examines the patient, and returns the letter and the results.
Patient: Books the clearance visit and confirms the physician's details.
Surgical and anesthesia team: Decides conditional clearances, refusals and missing items in the Decision Desk.
Callvu: Builds the request, sends, chases against the date, reads and checks, routes and files to the EHR.

Build the request
The physician is identified from the EHR and confirmed with the patient; the request is built from the case: the procedure and the date, the anesthesia plan, the patient's risk category under the policy, the items required (the examination, the medication management with the anticoagulant and antiplatelet plan, the tests by category such as the electrocardiogram or the laboratory panel, the condition-specific opinions such as cardiology for a cardiac history), and the date by which the clearance is needed.
Chase and verify
The request goes to the physician's office through their channel (direct message, e-referral, fax where that is all they take) with a link for the response; the patient is reminded to book the clearance visit; the office is chased on a clock set from the surgery date; the letter and the results are read on arrival and checked against the request: the patient and the procedure, the dates, each required item answered, the medication instructions stated, the restrictions or conditions, the signature.
Decide
A clearance that answers every item without conditions files by rule; a clearance with conditions (a medication change, a further test, a delay), a refusal, a letter that does not answer an item, or an office that does not respond before the cutoff goes to the surgical and anesthesia team in the Decision Desk with the letter and only the allowed outcomes (accept with the condition actioned, request the missing item, order the test internally, consult, or postpone the case).
Write back
The clearance letter and the results are filed to the EHR against the surgical case, the medication instructions are written to the pre-operative plan and sent to the patient through the instructions process, the day-of-surgery checklist is updated with the clearance status, and the physician's office receives the acknowledgment.

Where it ends: The clearance was requested with the specifics the case needed, chased against the surgery date, checked on arrival and acted on, and the EHR holds it against the case with the checklist updated. The Decision Trace shows the request's items, the checks and any decision; the Audit Trace shows the send, the chases, the arrival and the filing with time.

Runtime enforcement

What is enforcedwhile the work runs.

The regulations preloaded in Callvu Studio and the bank's own policies, applied as steps that run, not lines in a binder. A step that breaks a rule does not run, so a completed run was compliant.

Regulations

HIPAA Privacy Rule, disclosures for treatment (45 CFR 164.506) and the designated record set (45 CFR 164.501): The surgical team may request and the physician may disclose the clearance and the results for treatment without the patient's authorization; the clearance becomes part of the patient's designated record set once filed to the EHR, and the exchange is logged.
Pre-anesthesia and pre-operative evaluation standards (the ASA Practice Advisory for Preanesthesia Evaluation, the ACC/AHA perioperative cardiovascular evaluation guideline, the Joint Commission provision of care standards requiring a pre-anesthesia assessment): The standards set the elements of the pre-operative evaluation by risk category, the indications for testing and for cardiology or other consultation, and the perioperative medication management including the anticoagulant plans; the request lists the items the policy derives from them, and the checks confirm each was answered.
Hospital and ambulatory surgery center medical staff policies and CMS Conditions of Participation on the history and physical (42 CFR 482.22 and 482.51): A history and physical within the required period before surgery (thirty days, updated within twenty-four hours of admission) and the pre-operative assessment are conditions of participation; the clearance and its date are checked against the period.

Company policies

The request names the items the policy requires for this patient; a generic clearance request is not sent.
The office is chased against the surgery date, and the patient is reminded to book the clearance visit.
A conditional clearance is actioned, not filed; the team decides with the letter in view.
The EHR holds the clearance against the case, and the checklist reads it.

Controls

Physician identification and request building from the case.
Secure send with a response link.
Chases on the date-driven clock.
Reading and item-by-item checks.
Decision Desk for conditions, refusals and gaps.
EHR filing, pre-operative plan update and checklist update.

Clocks and deadlines

Clearance needed by: The policy's days before surgery, set from the case date.
History and physical validity: Within thirty days before surgery, with the update within twenty-four hours of admission.
Chase cutoff: The point before surgery at which an unanswered request goes to the team.

Documents and checks

The request with its items
The clearance letter and the results as received and checked
Any decision
The EHR filing and the checklist update

In the Decision Trace

The items required and the policy basis.
Each item's check.
Any decision and the person.

In the Audit Trace

The send with channel and time.
Each chase and the arrival with time.
The filing and the updates.

The handoff

Between the front doorand the back office.

The front door

The physician's office through its channel and link; the patient reminded on their phone to book the visit.

The back office

The surgical and anesthesia team sees only conditional, refused or missing clearances; the checklist reads the EHR.

The Decision Desk

A conditional clearance, a refusal, an unanswered item or a non-responsive office goes to the surgical and anesthesia team in the Decision Desk with the letter and only accept with the condition actioned, request the item, order internally, consult, or postpone.

Proof

In scope.Proof at scale, not one process at a time.

The kind of process Callvu runs in production for customers in this industry. Ask for a reference on this exact process. The results below are the industry's published proof; each claim code links to its record on agents.callvu.com.

23 hospitals in the Ministry of Health network run on Callvu.

Across Callvu customers

More than 1,000 processes are live across Callvu customers.

Across Callvu customers

Questions

What buyers ask next,answered plainly.

What does the clearance request ask for?

The items the policy requires for the patient's risk category: the examination, the medication management including the anticoagulant plan, the tests by category, and any condition-specific opinion, with the procedure, the date and the deadline.

What happens if the letter has conditions?

It goes to the surgical and anesthesia team in the Decision Desk with the letter; the condition is actioned (a medication change sent to the patient, a test ordered, a consult) or the case is postponed, never filed and forgotten.

How is the date protected?

The office is chased on a clock set from the surgery date, and an unanswered request reaches the team at the cutoff with time to act.

Related processes

Pre-procedure document collection Pre-anesthesia assessment Day-of-surgery readiness check Outbound referral to a specialist Try it in the sandbox All healthcare processes

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