“Connecting the right patient, with the right surgeon, and the right pathway.”

Risk Variable and Identifiers

First Name

Last Name

Date of Surgery
 

Date of Collection
 

Mode of Collection

Responder

Date of Birth
 

Health Insurance claim Number (HICN)

Race

Ethnicity

BMI

Height

Weight

Health Literacy : How comfortable are you filling out medical forms by yourself?

Back Pain (Preoperative): What amount of pain have you felt in your back at the moment?

What amount of pain have you experienced in the last week in your other Knee/Hip?

Has patient used narcotic chronically before surgery (90 days or more)?