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Surgical Procedure
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Date of surgery
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Symptom Status
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Assistive devices?
• • •
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Pain score (0-10)
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Pain frequency
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Nausea/Vomiting?
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Fever/Chills?
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Swelling?
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Calf tenderness?
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Wound healing?
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Pain medication?
• • •
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Post-op physical therapy?
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Home exercises?
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Work Status
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Additional Information
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