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Postoperative Evaluation
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Cervical Procedure
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Thoracic Procedure
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Cranial Procedure
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Lumbar Procedure
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Peripheral Procedure
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status post
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Procedure:
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Cervical
• • •
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additional procedure:
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Thoracic
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Lumbar
• • •
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additional procedure
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Cranial
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Peripheral
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Additional Notes
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How are feeling?
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Additional Notes
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Headache
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Additional Notes
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Fever
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Additional Notes
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Pain length of time
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day(s)/week(s)/month(s)
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Complaints
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Pain
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No Complaints
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side
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Location of pain
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Severity
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Additional Notes
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Quality
• • •
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Additional Notes
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Associated symptoms
• • •
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Location of upper extremity symptoms
• • •
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Neck Symptoms
• • •
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Location of lower extremity symptoms
• • •
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Location of lower extremity symptoms
• • •
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Additional Notes
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Cauda equina symptoms
• • •
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Aggravating factors
• • •
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Additional Notes
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Alleviating Factors
• • •
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Additional Notes
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Medications
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Additional Notes
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Incision
• • •
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Additional Notes
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Vitamin D Status
• • •
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Patient is using
• • •
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Additional Notes
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Immobilization used
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Type of Immobilization device
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Patient is using lumbar brace
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Additional Notes
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Physical Therapy PT
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Physical Therapy Notes
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Physical Therapy Referral - NeuroSpine
• • •
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Physical Therapy Comments
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Notes
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