Incision and Drainage Discharge Instructions
Please review and acknowledge your post-procedure care instructions after your incision and drainage procedure.
Patient Full Name
*
First Name
Last Name
Date of Procedure
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Procedure Site (Location of Incision)
*
Name of Responsible Provider
*
Contact Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Wound Care Instructions
*
Medication Instructions (e.g., antibiotics, pain relief)
*
Signs and Symptoms to Watch For (select all that apply)
*
Increased redness or swelling
Pus or unusual drainage
Fever or chills
Severe pain not relieved by medication
Other (please specify)
Follow-Up Appointment Date (if scheduled)
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Hour Minutes
AM
PM
AM/PM Option
Instructions for When to Seek Immediate Medical Attention
*
Additional Questions or Concerns
Patient Signature
*
Submit Discharge Instructions
Submit Discharge Instructions
Should be Empty: