Post-Surgical Outpatient Assessment
Patient Name
Date of Assessment
Medical Record Number
Procedure Performed
Date of Surgery
Surgeon
Presenting Concerns / Symptoms
Vital Signs
Temperature
Blood Pressure
Pulse
Respiratory Rate
Wound Assessment
Pain Assessment
Mobility Status
Bowel/Urinary Status
Current Medications
Plan / Recommendations
Next Appointment
Reviewed by (Clinician)