For more information call: 480.725.9777
Home
About Us
Bios
Dr. Doug S. Clouse
Dr Danton Dungy
Dr. Adam Farber
Dr. Stephen Hatfield
Dr. Benjamin MacQueen
Dr. George Myo
Dr. Steven Porter
Dr. Gregory Stewart
FAQs
Forms
Post-Op Telephone Call
Patient Satisfaction Survey
Contact/Location
Preparing for Surgery
Helpful Reminders
General Information
Advance Directives
Preop Guidelines
Before Your Surgery
Day of Surgery
After the Surgery
Patients Rights and Responsibilities
Post-Op Telephone Call
Home
/
Forms
/
Post-Op Telephone Call
Post-Op Telephone Call
support
2015-09-14T05:18:37+00:00
Post-Op Telephone Call
Phone Number
Procedure
Block:
Yes
No
Spoke To:
Patient
Spouse
Parent
Other
PROBLEMS: Are you having problems with?
Nausea/Vomiting
Yes
No
Dressing comfortable
Yes
No
Elevated temperature
Yes
No
Excessive Swelling
Yes
No
Drainage/Bleeding
Yes
No
Numbness
Yes
No
Pain under control
Yes
No
Discharge instructions
Yes
No
Rate pain level:
1
2
3
4
5
6
7
8
9
10
OTHER/EXPLAIN
Follow up appointment made:
Yes
No
Reminded to call to schedule appt.
First Attempt:
Date/Time:
Left Message
Busy
No answer
Other:
RN
Second Attempt:
Date/Time:
Left Message
Busy
No answer
Other:
RN
Third Attempt:
Date/Time
Left Message
Busy
No answer
Other:
RN
Letter sent out to patient
Date/Time
RN
Verification
Please enter any two digits
*
Example: 12
This box is for spam protection -
please leave it blank
:
