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FUE/ARTAS OPERATIVE REPORT
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HT OPERATIVE REPORT
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GR OPERATIVE REPORT
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Chart #
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Weight
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Allergies
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Allergic to?
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Vitals
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Start
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Time
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B/P
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Pulse
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O2
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Time
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B/P
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Pulse
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O2
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Time
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B/P
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Pulse
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O2
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End
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Time
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B/P
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Pulse
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O2
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SURGERY MEDICATION
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Valium
• • •
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@
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Valium
• • •
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@
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Valium
• • •
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@
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DEMEROL 50 tab PO
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mg
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@
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mg
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@
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HALCION .25mg tab
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mg
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@
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mg
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@
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TORADOL 10mg PO
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Tabs
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@
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CEPHALEXIN 500mg
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Tabs
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@
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CLINDAMCIN 300mg
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|
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Tabs
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@
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DOXYCYCLINE 100mg
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|
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Tabs
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@
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CELEBREX 200mg
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Tabs
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@
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PEPCID 40mg
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|
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Tabs
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@
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PERCOCET 5-325
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Tabs
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@
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VICODIN
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Tabs
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@
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Tabs
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@
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ZOFRAN ODT 8mg SL
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Tabs
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@
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Tabs
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@
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TYLENOL 500mg
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Tabs
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@
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Tabs
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@
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Max Dose Carpule
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USED Carpules
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Kenalog 40mg IM
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DELTOID by
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Tumescence [100cc NS + 1cc 1:1000 epi]
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Donor area cc's
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Recipient area cc's
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Total cc's
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Comment
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Xylocaine 2%1:100,000epi (Red) [1.8ml vial]
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Donor Area
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__/Vials @
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Recipient Area
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__/Vials @
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__/Vials @
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__/Vials @
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__/Vials @
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Septocaine HCI & epinephren 1:100:00
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|
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Donor Area
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__/Vials @
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Recipient Area
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__/Vials @
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__/Vials @
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Marcaine .5% 1:200,000epi (Blue) [1.8ml vial]
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|
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Donor Area
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__/Vials @
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__/Vials @
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Recipient Area
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|
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__/Vials @
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Exparel 20cc
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__CC's
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EPI 1:50 (super juice)
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Recipient Area
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__CC's
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__CC's
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PRP System?
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PRP
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PRP Total
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Added PPP #
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Total Amount
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Donor Total CC's
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Recipient Total CC's
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FUE HARVEST START TIME
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FUE HARVEST END TIME
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HARVEST #
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DONOR START
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DONOR CLOSE
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3/0 PROLENE
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DONOR WIDTH____CM
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3/0 VICRYL
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DONOR DENSITY
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DONOR STRIPS____CM
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ARTAS - Difficulty
• • •
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DONOR LENGTH____CM
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ARTAS Needle Size
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POST OP MED'S
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PREDNISONE 10mg #9
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CEPHALEXIN 500mg #10
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VICODIN #10
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PERCOET 5/25 #10
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AMBIEN 10MG #5
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ZOFRAN 8MG #3
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POST OP SPRAY 8oz BLT. #1
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SHAMPOO
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OTHER
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Strip - Tight Closure/Bleeding Donor Area
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Bleeding Recipient Sites
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Popping/Shallow Sites
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Vagal Reaction
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Difficult Anesthesia
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Number of Graft Removed
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Graft Temperature
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Comment
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Placers
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Left
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Right
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Crown
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Sites
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Placers Start Time:
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Sites
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Sites
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Sites
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Sites
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Lunch time:
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Sites
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Sites
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Sites
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Sites
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End Time
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GRAFT TOTALS
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1's
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2's
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3's
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Total Grafts
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Comments
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