Personal Medical Records on Operations or Surgeries

Personal Medical Records on Operations or Surgeries

If an individual has undergone an operation or surgery or any medical procedure, the personal medical records should contain at least the following:

  • Operative records (especially the technique of the surgeon)
  • Anesthesia records (if done under general or regional anesthesia or other forms)
  • Histopathology reports or biopsy reports (formal or informal written document)
  • Clinical abstract or discharge summary
  • Statement of accounts

ROJ@16feb18

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