Cesarean Section Post-Operative Follow-Up Form
Patient Name
Date of Birth
Medical Record Number
Date of Cesarean Section
Date of Follow-Up
Indication for Cesarean Section
Physical Examination
Vital Signs
Wound Status
Intact
Redness
Discharge
Dehiscence
Pain Level (0-10)
Breastfeeding
Yes
No
Lochia Description
Urinary/Bowel Function
Psycho-Emotional Status
Medications
Follow-Up Plan / Advice
Provider Name
Signature