PREOP Dx
• • •
|
PreOp Dx Free text
|
Post Op Dx
• • •
|
Post Op Dx Free Text
|
Operation
• • •
|
Operation Free Text
|
Anesthesia
• • •
|
|
Time OUT
|
|
Location of Lesion(s)
|
|
Set up
|
|
Details
• • •
|
|
Details of the procedure
|
|
Deep closure
• • •
|
Deep closure stitch
• • •
|
Deep dermis suture
• • •
|
|
Skin closure stitich
• • •
|
Type of skin stitch
• • •
|
same for multiple lesions
|
|
Steri strips
|
|
Findings
• • •
|
Findings
|
Specimen(s) Resected
|
Weight of specimen
|
|
Sent to Path
|
EBL (cc's)
|
|
No complications
|
Complications Free Text
|
|
|
|
|
|
|
|
Urine Output
|
Lesion Excision
|
Surgery stop time
|
Specimen Resected
• • •
|
Anesthesia Stop Time
|
IV fluid
|
Reference Number
|
Surgery Start Time
|
Fill volume
|
Anesthesia Start Time
|
Reference number
|
Right Breast Implant
• • •
|
Fill Volume
|
Serial Number
|
Injection volume
|
Left Breast Implant
• • •
|
Aspirate volume
|
Serial Number
|
Injection Volume
|
lipo area #1
• • •
|
Aspiration Volume
|
Lipo area #2
• • •
|
Injection Volume
|
Lipo area #3
• • •
|
Aspiration Volume
|
Lipo Area #4
• • •
|
Injection Volume
|
Lipo Area #5
• • •
|
Aspiration Volume
|
Lipo Area #6
• • •
|
Injection Volume
|
Lipo Area #7
• • •
|
Aspiration Volume
|
Lipo Area #8
• • •
|
Injection Volume
|
Lipo Area #9
• • •
|
Aspiration Volume
|
Lipo Area #10
• • •
|
Injection Volume
|
Total Volume Injected
|
Aspiration Volume
|
|
Injection Volume
|
|
Aspiration Volume
|
|
Injection Volume
|
|
Aspiration Volume
|
|
Injection Volume
|
|
Aspiration Volume
|
|
Total Aspirate
|