Joint Replacement Surgery Post-Operative Assessment Form
Patient Information
Patient Name
Patient ID
Date of Birth
Date of Surgery
Type of Joint Replaced
Hip
Knee
Shoulder
Other
Side
Left
Right
Bilateral
Pain Assessment
Pain Level (0-10)
Pain Description
Wound Assessment
Wound Healing
Good
Delayed
Infected
Presence of Drainage
None
Serous
Purulent
Bloody
Comments
Mobility Status
Mobility Aids
None
Walker
Crutches
Cane
Wheelchair
Mobility Level
Range of Motion (ROM)
ROM Measurements
Complications
Any Post-Op Complications?
Medications
Current Medications
Follow-Up
Plan for Follow-Up
Assessor Details
Assessor Name
Date