Recovery Tracker

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Name

First

Last

Date / Time

Phone

Operating Doctor

Surgery Type

HASTI Survey

	None - 1	Mild - 2	Moderate - 3	Strong - 4	Severe - 5
Heaviness	None - 1Heaviness None - 1	Mild - 2Heaviness Mild - 2	Moderate - 3Heaviness Moderate - 3	Strong - 4Heaviness Strong - 4	Severe - 5Heaviness Severe - 5
Achiness	None - 1Achiness None - 1	Mild - 2Achiness Mild - 2	Moderate - 3Achiness Moderate - 3	Strong - 4Achiness Strong - 4	Severe - 5Achiness Severe - 5
Swelling	None - 1Swelling None - 1	Mild - 2Swelling Mild - 2	Moderate - 3Swelling Moderate - 3	Strong - 4Swelling Strong - 4	Severe - 5Swelling Severe - 5
Throbbing	None - 1Throbbing None - 1	Mild - 2Throbbing Mild - 2	Moderate - 3Throbbing Moderate - 3	Strong - 4Throbbing Strong - 4	Severe - 5Throbbing Severe - 5
Itching	None - 1Itching None - 1	Mild - 2Itching Mild - 2	Moderate - 3Itching Moderate - 3	Strong - 4Itching Strong - 4	Severe - 5Itching Severe - 5

/ Operating Name

Heaviness: (That feeling when your e.g. legs seem heavier than usual, like they’re tired or hard to move)
Achiness: (A dull, nagging discomfort in your e.g. legs, like they’re sore or tired)
Swelling: (Visible or physical swelling in the legs)
Throbbing: (A pulsing or beating feeling, coming in waves)
Itching: (Irritation or itching in the affected area)

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Contact Us

Caribbean Vascular & Vein Clinic

St. Clair Medical Center
18 Elizabeth Street,
St. Clair, Port of Spain
Trinidad, West Indies.

1(868) 622 9665
1(868) 221 2673

CLINIC HOURS
MON-FRI: 8AM – 4PM
SATURDAY: 9AM – 2PM
SUNDAY: CLOSED