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ACCEPTABLE OPERATIVE REPORT # 1
This operative report follows the standards set by the JCAHO and AAAHC
for sufficient information to:
• identify the patient
• support the diagnosis
• justify the treatment
• document the postoperative course and results
• promote continuity of care
This operative report also provides:
• name of facility where procedure was performed
• date of procedure
• patient history
• CPT code
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Blair General Hospital
123 Main Street
Anytown, USA 56789
Patient Name: Betty Doe
Date: January 1, 2005
Preoperative Diagnosis: Bilateral upper eyelid dermatochalasis
Postoperative Diagnosis: Same
Procedure: Bilateral upper lid blepharopoasty, (CPT 15822)
Surgeon: John D. Good, M.D.
Assistant: N/A
NAME: Doe, William
Anesthesia: Lidocaine with l:100,000 epinephrine
Anesthesiologist: John Smith, M.D.
Dictated by: John D. Good, M.D.
This 65-year-old female demonstrates conditions described above of excess and
redundant eyelid skin with puffiness and has requested surgical correction. The