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Preop Dx
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Postop Diagnosis
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Procedures
• • •
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Addnl Procedures
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Surgeon
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Assistant
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Anesthesia
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Anesthesiologist
|
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Analgesia Used
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Amount Used
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Estimated Blood Loss
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Wound Prep used
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Service Location
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Brief Consent Note
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Operative Report
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Wound 1
|
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Wound Length
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Location
• • •
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Wound 1
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Wound extent
|
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Wound evaluation
• • •
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Method of repair
• • •
|
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Deep Sutures used
• • •
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Superficial Sutures
• • •
|
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ATT
|
|
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FTSG
|
donor site location
|
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Other comments
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Integra Placement
|
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Wound 2
|
|
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Wound 2 Length
|
Location
• • •
|
|
Wound 2
|
Deep Sutures used
• • •
|
|
Superficial Sutures
• • •
|
ATT
|
|
FTSG 2
|
donor site location
|
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Other comments
|
Integra Placement
|
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Wound Classification
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Patient Disposition
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Complications
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Dressing used
• • •
|
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Postop instructions
• • •
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Follow up
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Post OP Antibiotics
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Contact the office
|
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Justification of complex closure
|
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