GP Clinic – Minor Surgical Procedure Record
Patient Details:
John Smith
12/03/1960, NHS Number: 1234567890
Date and time of procedure: 01/11/2024 10:00
Name of clinician performing procedure: Dr. Jane Doe
Name of nurse or assistant present: Nurse Sarah Green
Referral & Clinical Background:
Referring clinician or source: Self-referral
Lesion history, including onset, duration, and symptoms: The patient noticed a small, dark mole on his back approximately 6 months ago. It has gradually increased in size and has recently started to itch occasionally.
Lesion Description:
Lesion characteristics – size, colour, surface, border: 6mm, irregular border, dark brown, slightly raised surface.
Lesion location: Upper back
Previous treatment(s) for lesion: None
Provisional diagnosis: Suspicious naevus
Procedure Details:
Procedure performed:
[x] Ellipse Excision
[ ] Flap
[ ] Punch Biopsy
[ ] Other: [Specify]
Anaesthetic used:
[x] Lignocaine 1%
[ ] Lignocaine 2%
[ ] Lignocaine with Adrenaline
Anaesthetic dose in mL: 2mL
Batch number of anaesthetic: ABC123
Expiry date of anaesthetic: 01/01/2026
Sutures:
Type and size of sutures: 4/0 Vicryl
Number of sutures placed: 4
Dressings:
Dressings applied post-procedure: Steri-strips and a light dressing
Post-Operative Instructions:
Patient advised on:
[x] Wound care
[x] Signs of infection
[x] Analgesia
[x] Emergency contact
Date of next check / dressing change: 7 days
Planned number of days until suture removal: 10 days
Return to:
[x] Own GP
[x] This clinic
Histology:
Specimen sent:
[x] Yes
[ ] No
Specimen site/description: Excision of suspicious naevus, upper back
Laboratory or courier details: Pathology Lab, City Hospital
Histology result:
[ ] Awaiting
[x] Received
Action required based on histology result: Patient to be informed of results and further management plan discussed.
Sign-off:
Clinician name and signature: Dr. Jane Doe (signed)
Date of clinician sign-off: 01/11/2024
Nurse/assistant name and signature: Nurse Sarah Green (signed)
Date of nurse/assistant sign-off: 01/11/2024