Hip Evaluation Form

The Hip Evaluation Form was designed to evaluate and examine patients
coming in complaining of hip pain or trouble. The form includes the
following sections:

  • HPI open documentation of the knee(s)
    • Previous Surgeries
    • General Comments
    • Sciatica
  • Function Evaluation
  • X-Ray Evaluation
  • Physical Examination
  • Diagnosis / Plan
 

Hip Replacement Form

This form details everything pertaining to the hip replacement surgery including post surgical findings. This form includes the following key components:

  • Primary Diagnosis
  • Surgery Type
  • Prosthesis Type
  • Surgical Approach
  • Type of Fixation
  • Approach
  • Bone Quality
  • Bone Graft
  • Collar Seating
  • Surgical Time Notation
  • Surgical Findings Open Dictation

 

 

Knee Evaluation Form

The Knee Evaluation Form is a comprehensive and detailed form designed
to document the full examination of knee exam for orthopedic purposes.
The form features the following key components: 

  • HPI open documentation of the knee(s)
    • Previous Surgeries
    • Treatments
  • Function Evaluation
  • X-Ray Evaluation
  • Physical Examination
  • Diagnosis / Plan

 

 

Knee Replacement Form

Much like the Hip Replacement Form, this form was also designed specifically
for Orthopedic Surgeons. This form features the following components:

  • Primary Diagnosis
  • Surgery Type
  • Approach to Knee
  • Lateral Patellar Release
  • Prosthesis Type
  • Type of Fixation
  • Ligament Release
  • Area of Graft
  • Ligament Advancement
  • Patellar Disease & Patellar Tendon Transfer
  • Surgical Time Notation
  • Surgical Findings Open Dictation