Brief Operation Note Template
| Date/Time |
Preop diagnosis: reason
for surgery
Postop diagnosis: actual finding
at surgery
Procedure: performed
Anesthesia: type; i.e, general,
spinal, epidural, etc
Surgeon: attending physician
Assistant(s): resident/medical
student
Estimated Blood Loss:
IV Fluids:
Urine output:
Findings: in detail what was found
at surgery, describe sizes, Adhesions, etc
Pathology: what was sent to the
pathologist for evaluation
Disposition: where patient is going
from operating room
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