DATE AND TIME: [Date and time]
URGENCY: Elective / Non-elective
SURGEON: [Name]
ASSISTANT: [Name / None]
ANAESTHETIST: [Name]
OPERATION: Axillary Node Clearance (Level II / Level III)
ANAESTHETIC: General anaesthesia
ANTIBIOTICS: [Drug and dose / Not indicated]
DVT PROPHYLAXIS: [Agent / mechanical / Not indicated]
POSITION: Supine with ipsilateral arm abducted, forearm suspended [or on arm board]
INDICATION:
Breast cancer with confirmed axillary nodal metastases. [Positive sentinel node biopsy / palpable axillary nodes / prior sampling positive].