SECTION 2 — Surgeon Validation Checklist

1.Diagnosis Confirmed *

Diagnosis confirmed and documented

Primary pathology clearly explains symptoms and functional limitation.

2.Imaging Reviewed Personally *

Imaging personally reviewed by surgeon (MRI / X-ray / CT)

Images are available on site or within the system.

3.Does the surgeon agree with the radiologist’s interpretation? *

Yes — findings are concordant

No — surgeon interpretation differs

4.Imaging–Exam Concordance Verified *

Imaging findings are concordant with physical examination and symptom pattern

5. Laterality & Surgical Site Confirmed

Correct side and anatomic site confirmed

(Example: Right knee medial meniscus, Left shoulder rotator cuff)

Surgical Side & Anatomic Site

6.Conservative Care Failure Verified *

Failure of appropriate non-operative treatment verified

Includes: Physical therapy, Injections Medications ,Activity modification ,OR documented clinical rationale for bypassing conservative care.

7. Surgical Indications Summarized *

(Tie symptoms, exam, imaging, and failed conservative care together)

8.Procedure Strategy Selected *

Surgical strategy selected and documented

Examples: Repair vs debridement vs reconstruction, Arthroscopic vs open, Primary vs revision

9. Alternatives to Surgery Discussed *

Non-operative and alternative treatment options reviewed with patient

Patient understands surgery is elective and alternatives exist.

10.Patient Understanding Confirmed *

Patient demonstrates understanding of diagnosis and reason surgery is recommended

This is acknowledgment, not legal consent.

Stage 1 Completion Attestation *

All Stage 1 criteria have been met and patient is appropriate to advance