Post Operative Phone Call Sheet printable pdf download

Post Operative Phone Call Sheet

POST OPERATIVE PHONE CALL SHEET

Patient Name:

________________________________________________________

Patient Number:

________________________________________________________

Phone Number:

________________________________________________________

________________________________________________________________________

Date

Respondent

Caller

General Condition stated by Patient or Significant Other:

Excellent _____ Good _____ Fair _____ Poor _____

Tolerated Diet: Yes____ No ____

Nausea/Vomiting: Yes____ No ____

Drainage from incision: Yes ____ No ____ Type: __________________Amount:___________

Fever: Yes ____ No ____

Temperature: _____

Pain: Severe ____ Moderate _____ Slight _____ None _____ Pain Medication Taken ________

Other:_________________________________________________________________________

______________________________________________________________________________

Attempt: ____________________________________________________________________

Date

Time

Caller

Reason Not Reached

Attempt ____________________________________________________________________

Date

Time

Caller

Reason Not Reached

Attempt ____________________________________________________________________

Date

Time

Caller

Reason Not Reached

Post Operative Phone Call Sheet