Cardiac Surgery Post-Operative Follow-up Form
Patient Information
Patient Name
Hospital Number
Date of Birth
Age
Sex
Male
Female
Other
Surgery Details
Surgery Date
Procedure
Surgeon
Current Visit
Follow-up Date
Visit Number
General Health Status
Good
Fair
Poor
Clinical Assessment
Blood Pressure
Heart Rate
Temperature (°C)
Respiratory Rate
Weight (kg)
Symptoms/Complaints
Medications
Current Medications
Investigations
Relevant Recent Investigations
Complications
Complications (if any)
Plan / Recommendations
Plan / Recommendations