|
Originally Posted by John S on February 9, 2005
AGE AT SURGERY DATE:
AGE AT SURGERY DATE: 55
SURGEON: Dr. Zeegers
SURGERY LOCATION/CLINIC: Alphaklinik
DEVICE(s), LEVEL(s): Charite L4-5
COST =
AMOUNT BILLED:
INSURANCE ALLOWED:
OUT OF POCKET:
TRAVEL:
EXPLANATIONS?
ONSET OF LUMBAR PROBLEMS, DATE OF INJURY, CAUSE, ETC...:
PRIOR SPINE SURGERIES AND PROCEDURES (IDET, ESI, etc...):
PRE-OP MEDICATIONS:
PRE-OP DIAGNOSTICS (discogram, nerve root blocks, etc...):
PRE-OP NEUROPATHIES (what, where, & degree of pain, numbness, tingling, sexual/bladder/bowel symptoms, etc.):
PRE-OP CONDITION (Please include %leg pain/% back pain, pain levels, type of pain, ability to work and function, disability status, etc.... be direct, but be as verbose as you need to):
TIME POST-OP AT ORIGINAL POST HERE:
DESCRIBE YOUR SURGICAL EXPERIENCE:
RATE FUNCTIONALITY / SATISFACTION AT INTERVALS BELOW:
FUNCTIONALITY:
1. Very poor: much worse... disabled after surgery.
2. Poor: worse after surgery.
3. Neutral: No improvement, or improvements offset by new problems.
4. Fair, some improvement, limitations are still serious.
5. Good, substantial improvement, some limitations.
6. Excellent: no limitations.
SATISFACTION:
1. Very sorry I had the surgery.
2. Somewhat sorry I had the surgery.
3. Too soon to tell, or I'm ambivalent about the surgery.
4. I'm somewhat glad I did my surgery.
5. I'm very glad I did my surgery.
FUNCTIONALITY: ___ SATISFACTION: ___ [6 WEEKS POST-OP]
FUNCTIONALITY: ___ SATISFACTION: ___ [3 MONTHS POST-OP]
FUNCTIONALITY: ___ SATISFACTION: ___ [6 MONTHS POST-OP]
FUNCTIONALITY: _5__ SATISFACTION: _4__ [1 YEAR POST-OP]
FUNCTIONALITY: ___ SATISFACTION: ___ [2 YEARS POST-OP]
6 WEEKS POST-OP - DESCRIBE LIFESTYLE / PAIN / MEDICATIONS / NEUROPATHIES / ECT... (discuss surgery induced symptoms [leg pain?]):
3 MONTHS POST-OP - DESCRIBE LIFESTYLE / PAIN / MEDICATIONS / NEUROPATHIES / ETC... (discuss surgery induced symptoms [leg pain?]):
6 MONTHS POST-OP - DESCRIBE LIFESTYLE / PAIN / MEDICATIONS / NEUROPATHIES / ETC... (discuss surgery induced symptoms [leg pain?]):
1 YEAR POST-OP - DESCRIBE LIFESTYLE / PAIN / MEDICATIONS / NEUROPATHIES / ETC... (discuss surgery induced symptoms [leg pain?]):
At one year, all leg symptoms have disapeared. I still get back aches from work/stress but I recover quickly. I am satisfied with my condition. Hopefully there will be even more improvement in the next year, but if there is not, I am still happy with this outcome.
2 YEARS POST-OP - DESCRIBE LIFESTYLE / PAIN / MEDICATIONS / NEUROPATHIES / ETC... (discuss surgery induced symptoms [leg pain]):
3 YEARS POST-OP - DESCRIBE LIFESTYLE / PAIN / MEDICATIONS / NEUROPATHIES / ETC... (discuss surgery induced symptoms [leg pain?]):
4 YEARS POST-OP - DESCRIBE LIFESTYLE / PAIN / MEDICATIONS / NEUROPATHIES / ETC... (discuss surgery induced symptoms [leg pain?]):
5 YEARS POST-OP - DESCRIBE LIFESTYLE / PAIN / MEDICATIONS / NEUROPATHIES / ETC... (discuss surgery induced symptoms [leg pain?]):
6 YEARS POST-OP - DESCRIBE LIFESTYLE / PAIN / MEDICATIONS / NEUROPATHIES / ETC... (discuss surgery induced symptoms [leg pain?]):
7 YEARS POST-OP - DESCRIBE LIFESTYLE / PAIN / MEDICATIONS / NEUROPATHIES / ETC... (discuss surgery induced symptoms [leg pain?]):
|