Orthopedic Post-Discharge Follow-up Form
Patient Name
Date of Follow-up
Patient ID
Date of Discharge
Diagnosis / Procedure
Current Symptoms
Pain Level (0-10)
Mobility Status
Independent
With Assistance
Bedbound
Medications (List and Dosages)
Wound Status
Physiotherapy / Rehabilitation Progress
Complications / Concerns
Follow-up Recommendations
Clinician Name
Clinician Signature
Date