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Patient Name/DOB/Phone
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Surgeon that performed procedure?
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Person you spoke to?
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Day/Time of 1st Call
|
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Day/Time of 2nd Call
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Relationship to patient?
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Information Discussed?
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Day/Time of 3rd Call
|
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Are you having any nausea?
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How is the Patient Feeling?
|
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Are you experiencing any dizziness?
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Nausea Comments:
|
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Is your dressing clean & dry?
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Dizziness Comments:
|
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Is there any bleeding at the site?
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Dressing Comments:
|
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Are you moving around the house well?
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Site Bleeding Comments:
|
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Aware of follow up appointment date?
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Mobility at Home Comments:
|
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Staff Caller Name:
|
Follow Up Appointment Comments:
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