Mastectomy Post-Operative Follow-Up Record
Patient Information
Patient Name
Age
MRN
Date of Surgery
Date of Visit
Current Condition
General Status
Vital Signs
Complaints/Symptoms
Wound Assessment
Wound Condition
Drainage
Signs of Infection
Other Findings
Drain Status
Type of Drain
Amount (ml)
Removed On
Treatment/Interventions
Medications
Wound Care
Other Interventions
Next Step/Plan
Follow-Up Date
Instructions/Remarks
Evaluator's Details
Name
Designation
Signature