Pre-op Diagnosis:
Post-op Diagnosis:
Procedure:
Findings:
Surgeon:
Assistant:
Estimated Blood Loss: TK mL
Specimen:
Type of Anesthesia:
Anesthesiologist:
IVF:
UOP:
Drains:
Plan:

OP#:

MIPS Quality Measure 21—Prophylactic Antibiotics:
MIPS Quality Measure 23—VTE Prophylaxis: