Transfer of Postoperative Care Note (Global Surgery)

Date/Time: [Date and time of note entry, YYYY-MM-DD HH:MM]

Author: [Author name, role/service, contact information]

Patient: [Patient name, MRN, DOB]

Encounter: [inpatient / outpatient / ASC], [Facility name and location]

Transfer Agreement

Index procedure(s): [Procedure name, laterality/site, procedure date] (If multiple procedures, list each separately.)
Transferring clinician/service: [Operating surgeon or surgical team name and contact]
Receiving clinician/service: [Name, role, service, location]
Effective transfer date/time: [YYYY-MM-DD HH:MM] (Use absolute date format; avoid relative terms like "today.")
Transfer end date: [Global period end date or "until released from surgical follow-up"]

Postoperative management responsibility for the above procedure is transferred from [Transferring Surgeon/Service] to [Receiving Clinician/Service] effective [YYYY-MM-DD HH:MM]. The receiving clinician accepts responsibility for postoperative management as defined below.

(If acceptance is not yet confirmed, replace the above statement with: "Proposed transfer of postoperative management from [Transferring Surgeon/Service] to [Receiving Clinician/Service] effective [YYYY-MM-DD HH:MM]. Acceptance pending. The operating surgeon/service remains responsible for postoperative management until acceptance is confirmed. Transfer is not finalized.")

Procedure and Clinical Context

(Summarize follow-up–relevant facts only; do not copy the full operative note.)

• Pre-op diagnosis: [Preoperative diagnosis]
• Post-op diagnosis: [Postoperative diagnosis] (Include only if different from pre-op diagnosis.)
• Procedure performed: [Procedure name, laterality/site, procedure date, facility]
• Perioperative course: [Complications: none / describe if present]; [Devices in place: drains / wound vac / catheters / casts / splints / none] (Include type, location, and settings if applicable.)
• Current status at transfer: [Wound appearance], [pain control status and regimen], [mobility and weight-bearing status], [active concerns if any]
• Pending results: [Pathology / cultures / imaging / none] — Responsibility: [Surgeon / Receiving Clinician] will follow up and communicate to patient.

Global Period

(Include only when the procedure has a defined global period.)

• Global period type: [0-day / 10-day / 90-day / requires verification]
• Start date: [YYYY-MM-DD]
• End date: [YYYY-MM-DD]
• Scope of transfer: [Full global period / Partial transfer from YYYY-MM-DD to YYYY-MM-DD]

Reason for Transfer

[Brief reason for transfer, 1–2 sentences]

Responsibilities

(Assign each responsibility to Surgeon, Receiving Clinician, or Shared.)

Routine Postoperative Care: Wound checks and dressing changes: [assignment, frequency]. Staple/suture removal: [assignment, target date]. Drain management and removal: [assignment, output threshold for removal]. Cast/splint care: [assignment].

Medications: Pain management and refills: [assignment, agents permitted, refill limits]. Antibiotics: [assignment, drug, duration]. VTE prophylaxis: [assignment, agent, dose, duration]. Other medications: [assignment, specify].

Complications and Escalation: Minor expected issues (seroma, mild erythema): [assignment]. Suspected infection, bleeding, or thromboembolic symptoms: contact [clinician name and method]. Return-to-OR decisions: [Surgeon]. Emergency presentation location: [designated ED/facility].

Testing and Results: Follow-up labs/imaging orders: [assignment, specify tests and timing]. Pending results follow-up: [assignment]. Result communication to patient: [assignment].

Rehabilitation: Weight-bearing and activity restrictions: [assignment, staged milestones]. PT/OT referrals: [assignment]. Work/disability documentation: [assignment].

After-Hours Coverage: Primary contact: [name, phone/pager]. Backup if unavailable: [name, phone/pager]. Escalation pathway: [instructions].

Handoff Communication

• Mode: [phone / in-person / secure message / EHR]
• Date/time of direct contact: [YYYY-MM-DD HH:MM]
• Questions addressed: [yes / no — if no, specify pending items]
• Records shared: [Operative note: available / pending], [discharge summary], [medication list], [wound care instructions], [imaging/labs]

(If operative note is unavailable, document what information is missing and any interim safety limitations.)

Follow-Up Plan

• Next appointment: [Date, time, location, or scheduling instructions] (Do not use "PRN"; provide explicit plan.)
• Expected milestones: [Drain removal timing], [suture/staple removal timing], [other time-based checks]
• Return precautions: [Bleeding soaking dressings, fever/chills, increasing wound drainage or redness, uncontrolled pain, shortness of breath, chest pain, leg swelling, neurologic changes, procedure-specific warnings]
• Contact information: Routine questions: [number/portal]. Urgent after-hours: [number]. Emergencies: [911 or specified ED].

Patient Notification

[Who informed the patient] on [date] explained that postoperative management will be transferred to [Receiving Clinician/Service], including how to seek help and where to present for urgent issues. Patient response: [accepts / declines / questions noted].

(If patient declines transfer, document that transfer will not occur and that [Transferring Surgeon/Service] remains responsible for postoperative management.)

Attestations

Transferring Clinician: "I am transferring postoperative management as described above effective [YYYY-MM-DD HH:MM]."

Signature: ______________ | Printed Name: [Name] | Date/Time: [YYYY-MM-DD HH:MM]

Receiving Clinician: "I accept postoperative management responsibility as described above effective [YYYY-MM-DD HH:MM]."

Signature: ______________ | Printed Name: [Name] | Date/Time: [YYYY-MM-DD HH:MM]

(If dual signatures are not possible, reference acknowledgment method: [co-sign / reply message / separate acceptance note] dated [YYYY-MM-DD HH:MM].)