Operatief operatief.pdf


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DEPARTMENT OF DERMATOLOGY MOHS SURGERY OPERATIVE REPORT Patient Identification Referring Physician: G N/A Pictures: G Pre-op G Intra-op G Post-op Tumor Site Pre-op dx: Post-op dx: G Same Indication: G Site G Size G Pathology G Recurrence G Incomplete excision G Indistinct borders Recurrence History: G Primary G Recurrent Allergies: G NKDA G Taking anticoagulants: G No G ASA G NSAID G Coumadin G Plavix G Preoperative Medication: G Meds reviewed reconciled G N/A G antibiotic G Other Pre-op Assessment of Regional Nodes by palpation: G N/A G Negative G Positive Vital Signs (Pre): Time Ht Wt: B/P:  P: Pain Score (Pre):/10 Time Out Conducted at: G AM G PM G Consent obtained G Verified Correct patient (Name, DOB) G Correct patient position G Correct procedure site and side (if applicable) G Correct procedure to be conducted Equipment/supplies present: Yes No NA Pre-op antiseptic: Chlorhexidine Betadine Alcohol Lid Scrub Procedural site is marked by proceduralist and verified: G Patient G Photo H P was performed just prior to the procedure or is available for review prior to the start: Yes No Anesthetic: G Lidocaine 1 with epi G Bupivacaine 0.25 with epi 1:200,000 Curettage: G Yes G No Skin specimens process for frozen sections Excision Size (cm) Post-Stage Size (cm) Blocks Blocks positive Stage I (preop Stage II Perineural invasion: G yes G no De.

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Using this Surgery Operative Report template guarantees you will save time, cost and efforts! It comes in Microsoft Office format, is ready to be tailored to your personal needs. Completing your document has never been easier!

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