Post-Surgical Home Visit Checklist

Date of Visit Patient Name Surgery Type/Procedure Caregiver/Family Present

Vital Signs

Temperature Pulse Blood Pressure Respiratory Rate

General Assessment

• Alert & Oriented
• Pain Assessed
• Appetite Checked
• Ambulation/Mobility
• Hydration Status

Incision/Surgical Site

• Clean
• Dry
• Dressing Intact
• Redness/Swelling
• Drainage/Discharge

Medications

Medications Taken As Prescribed Concerns/Side Effects

Wound Care

Wound Care Performed Notes

Other Assessments

• Urine Output
• Bowel Movements
• Drainage Tubes
• Medical Devices (if any)

Patient/Caregiver Education

• Post-Op Instructions Reviewed
• Medication Education Provided
• Emergency Signs Reviewed
• Next Follow-Up Discussed

Comments / Observations