|
ID#
|
|
|
Surgery Side
• • •
|
Surgery Type
• • •
|
|
Surgery Date
|
Revision Date
|
|
|
|
|
Skin
• • •
|
Surgical Healed
|
|
Drains
|
Touch Sensitivity
|
|
Keloid
|
|
|
|
|
|
Measurements & Landmarks
|
|
