Name:

Gender:

Age:

Ward Bed NO:

Hospitalization NO:

Surgical pathway:

Surgery name:

Time back to the ward:

Date

Time

T

P

BP

Dorsal artery pulsation

Puncture site bleeding

subcutaneous hematoma

Bilateral limb skin temperature

Surgery Limb skincolor

Bleeding

Sign

operative limb braking time

Clotting time

Condition change and treatment

signature

˚C

/min

mmHg

good

weak

unfelt

no

yes

no

Scope

(cm)

same

unsame

yes

no

s