Operating Surgeon:

Theatre Anaesthetist:

Elective/Emergency:

Operation:

Indication:

Operative Findings:

Incision:

Procedure:

Closure:

Complications:

Additional Procedures:

Specimen:

Sent for histology: Y/N

Anticipated Blood Loss (ml):

Antibiotic Prophylaxis:

DVT Prophylaxis:

Post-Operative Instructions: