[Hospital Name] [HospitalAddress]

Operation Record

[tableIPPatientInfo]

[Head Type Of Operation]	[:]	[OperationType]	Date	:	[SurgDate]
Start Time	:	[Start Time]	End Time	:	[End Time]

[Head Procedure]

[Procedure Name]

[Head PreOperativeDiag]

[PreOperativeDiag]

[Head PostOperativeDiag]

[PostOperativeDiag]

[Head Surgeon]

[Surgeon]

[Head Assistants]

[Assistants]

[Head Scrub]

[Scrub]

[Head Circulating]

[Circulating]

[Head Anesthesiologist]

[Anesthesiologist]

[Head TypeAnaesthesia]

[TypeAnaesthesia]

[Head Estimated Blood Loss]

:

[Estimated Blood Loss]

[Head No of Units]

:

[NoofUnitsTransfused]

[Head Blood Group]

:

[Bloodgroup]

[Head Specimens]

[Specimen]

[Head IntraOperative]

[IntraOperative]

[Head Operative Findings]

[Operative Findings]

[Head OperativeProcedure]

[OperativeProcedure]

Drains

[Head Drain Type]	[Com]	[Drain Type]
[Head No of Drains]	[Colun]	[No of Drains]

[Head WoundDescr]

[WoundDescr]

[Sponge count & IC]

[Sponge&Instrument]

[Head Remarks]

[Remarks]

[Head Operating Surgeon]

[OperatingSurgeon]

[Head Prepared By]
[PreparedBy]	Signature