Suture Removal Discharge Instructions Form
Please complete the following details to document discharge instructions and follow-up information related to suture removal.
Patient Full Name
*
First Name
Last Name
Date of Suture Removal
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Wound Site
*
Type of Suture Removed
*
Please Select
Absorbable
Non-absorbable
Staples
Other
Wound Care Instructions
*
Activity Restrictions
Signs & Symptoms to Monitor
*
Redness
Swelling
Increased pain
Drainage
Fever
Other
Next Follow-Up Appointment Date
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Provider Name
*
First Name
Last Name
Additional Comments
Submit
Should be Empty: