PHILIPPINE AIR FORCE

520TH AIR BASE WING

AIR FORCE GENERAL HOSPITAL
Colonel Jesus Villamor Air Base, Pasay City

POST – OPERATIVE VISIT INFORMATION SHEET

PATIENT INFORMATION REMARKS

Date/Time of Visit: ____________________________

Post op day: _______
Operation Performed:
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Patient’s Condition: _______________________________

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Patient’s reaction to his/her surgical experiences:

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Patient’s suggestion for improving post-op visit:

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Ward Nurse Signature Over Printed Name OR/RR Nurse Signature Over Printed Name

Last Name First Name Middle Initial Rank Age Ward