Surgical Chart

Patient Details

Patient name is required to create and save a new chart.

Full Name *

Age

Sex

Attach Handwritten Notes

Optionally, upload a photo of legacy handwritten notes instead of typing.

Handwritten Notes Image

Upload a clear picture of the patient's old chart or notes.

No background image uploaded.

PNG, JPG, or WEBP. Max 5MB.

Medical History (Optional)

Detail the patient's medical background and current issues.

Presenting Complaints

Past Medical History

Past Surgical History

Allergies

Current Medications (from History)

Social History (Optional)

Record patient's lifestyle habits.

Smoking

Vaping

Shisha

Alcohol

COVID-19 History (Optional)

Record COVID-19 infection and vaccination status.

History of COVID-19 Infection

COVID-19 Vaccinated

Patient History