Orthopedic Surgery Post-Operative Follow-Up Form
Patient Name
Date of Surgery
Date of Follow-Up
MRN / ID
Procedure
Surgeon
Operative Side
Left
Right
Bilateral
Current Complaints / Symptoms
Wound Status
Pain Level (0-10)
Mobility Status
Full weight-bearing
Partial weight-bearing
Non weight-bearing
Using walking aid
Bedridden
Medications
Complications (if any)
X-ray/Evaluation Findings
Physiotherapy/Instructions
Next Follow-Up Date
Doctor's Notes