Bone and Joint Center

University of Washington

Department of Orthopaedics & Sports Medicine

Surgical Worksheet

Surgery Date______

Surgeon:Winston J Warme

Pav OKR2 OK Main Only

Dx:

Surgical Procedure:ScopeOpen

Required Information:

Length of Stay:(1-2 Days 2-3 Days)Length of Surgery: (1 Hour 1.5 Hours 2 Hours)

Admission:OPLS  AM Admit  IPDay Before Surgery

First Post-op:Same Week2 Week1 WeekNoOther:

Anesthesia: ChoiceScalene BlockOther:

Labs:Routine: CBCArthroplasty or >40y/o: CBC/CMP/COAGS/Hep C/HCG/UAcC&SSed/CRP

Transfusion:None T + S Units (Arthroplasty) T + C Units (2 if Arthroplasty and pt of concern)

Consult:NoneMedicineSocial Work OrthoticsOther:

PAT Position:LateralBeach ChairSupineProneOther:

O/R Table:RegularFx TableRA TableC-ArmOther:

O/R X-ray:NoneC-ArmRegularHealthmateOther:

Special Equip:NoneCPM BedScope BoomMcConnellOther:

IMPLANTS:

PLEASE COMPLETE BOTH SIDES Filled out by/Date:
Please circle all Procedures that apply

Please also circle all Diagnoses that apply