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Subjective
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Surgical Procedure
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Date of Surgery
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Surgical Facility
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Subjective Notes
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Pain Score out of 10
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Using Assistive Device and/or brace?
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Assistive Device and/or brace in use
• • •
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Comments
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Has Patient Had Bowel Movement?
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Did they need assistance with BM?
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Medication used to assist in BM
• • •
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Objective
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Objective Notes
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A&O
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Erythema- Within Normal Limits
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Mastisol allergy
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Erythema Comments
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Clean, Dry and Intact?- Yes
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Clean, Dry and Intact?- Not In Normal Limits
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Comments
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Swelling around incision: Within normal Limits
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Swelling around incision: not Within normal Limits
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Swelling Comments
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Bandage removed
|
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Photo
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Photo
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Photo
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Photo
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Imaging header
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X-Rays
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ROH x-ray
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Assessment & Plan
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Diagnosis
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Old steris removed, cleaned
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Staples removed
|
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FU as scheduled
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X-ray order
• • •
|
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Precautions discussed
• • •
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Plan notes
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Elaine salutation
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