Orthopedic Post-Operative Evaluation Form
Patient Name
Date of Birth
Date of Surgery
Surgeon
Procedure
Chief Complaint / Reason for Follow-up
Current Symptoms
Physical Examination Findings
Wound Status
Clean
Redness
Drainage
Swelling
Range of Motion
Neurovascular Status
Imaging/Investigations
Rehabilitation / Physical Therapy
Medications
Complications
Plan / Recommendations
Next Follow-Up Date
Evaluator Name
Date of Evaluation