Informing physician, name
Item
Informing physician
text
Diagnosis
Item
Diagnosis
text
Designated surgery/medical procedure
Item
Designated surgery/medical procedure
text
Scheduled date
Item
Scheduled date
date
Postoperative hemorrhage
Item
Postoperative hemorrhage
boolean
Wound infection
Item
Wound infection
boolean
Wound healing disorder
Item
Wound healing disorder
boolean
Hematoma/Seroma
Item
Hematoma/Seroma
boolean
Neural and vascular lesions
Item
Neural and vascular lesions
boolean
Thrombosis
Item
Thrombosis
boolean
Pulmonary embolism
Item
Pulmonary embolism
boolean
Reoperation/revision of surgical area
Item
Reoperation/revision of surgical area
boolean
Possible procedure-specific complications
Item
Possible procedure-specific complications
text
Surgical scheme
Item
Surgical scheme
text
Location
Item
Location
text
Signature of patient
Item
Signature of patient or legal representative
text
Signature of physician
Item
Signature of informing physician
text