Spinal Surgery Post-Operative Follow-up Form
Patient Information
Name
Date of Birth
Medical Record #
Surgery Details
Date of Surgery
Type of Surgery
Surgeon
Current Symptoms
Describe current symptoms
Physical Examination
Wound Status
Motor Function
Sensory Function
Reflexes
Medications
Current Medications
Complications
Any complications since surgery?
Imaging
Recent Imaging Results
Plan
Follow-up Plan & Notes