Surgical Complications Registry

Form to collect post-surgical complication data

This form is 100% confidential and is for research purposes only.

Doctor Name (optional)

Patient ID

Surgery Date

Complication Date

Procedure

Complication Category

Age

Sex

Female

Male

BMI (Body Mass Index)

<20

21-25

26-30

31-35

36-40

>40

Comorbid Conditions

Hypertension

Diabetes Mellitus (DM)

Thyroid

Smoke

Other

Complication Photos

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