FORM k 1

Form K 1 ( Primary Knee)

Patient Name

Date of Birth (dd/mm/yyyy)

Hospital ID (UID, MRN, Number)

Gender

Hospital Name, City ( Location)

Operation Date (dd/mm/yyyy)

Anaesthesia Type

Patient ASA Grade

Surgeon Incharge

Side (*Please fill separate forms for Bilateral)

Implant Company

Implant Name

Name of the Cement Used ( If Any)

Indication For Surgery

Type of Procedure

Surgical Approach

Preoperative Fixed Flexion Deformity

Preoperative Flexion

Computer Navigation used ( yes/no)