Hip Primary Registry Form H1

Hip Primary Registry Form: Form H1

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Online Form H1

Form H 1 (Primary Hip)

Patient Name

Date of Birth

Hospital ID ( UID, MRN, number)

Gender

Hospital Name

City ( Location)

Operation Date

Anaesthesia Type

Patient ASA grade

Surgeon Incharge

Side( *please fill separate forms for Bilateral)

Indication for Surgery

Type of Procedure

Surgical Approach

Patient Position

Computer Navigation Used

Thromboprophylaxis Used

Bone Graft Used

Implant Company

If Others (Please Specify Here)

Implant Name

Name of the Cement Used ( If Any)

Surgeon UID ( To get Surgeon login

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