General Surgery
Name:
Date: Month January February March April May June July August September October November December Day 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 Year 2008 2009 2010 2011 2012
Level 1
Time spent on Procedure:
Scrub Circulate
Procedure: ____________________ Appendectomy Hemorrhoidectomy Anal Fistula_ Abscess Pilonidal_Cyst Hernia-Inguinal Hernia-Umbilical Hernia-Ventral_or_Incisional Biopsy-Liver Biopsy-Lymph_Node Biopsy-Breast Breast_Lumpectomy Amputations-Legs Amputations-Toes Revision-Amputation Debridment Excision_Lesion_or_Lipoma Muscle_Biopsy Incision_-_Drainage Gynecomastia
Level 2
Procedure: ____________________ Exploratory_Laparotomy Laparoscopic_Appendectomy Open_Cholecystectomy Laparoscopic_Cholecystectomy Gastrostomy Gastrectomy-Resection Pyloroplasty Colon_Resection Laparoscopic_Hernia Colostomy Colostomy_Closure Nissen_Fundoplication Mastectomy Splenectomy Laparoscopic_Splenectomy Thyroidectomy Parathyroidectomy Permacath Catheter_Insertions_Port-a-Cath Catheter_Insertions_Hemodialysis Catheter_Insertions_Peritoned_Dialysis Full_Thickness_Skin_Graft Organ_Harvesting Tissue_Procurement Gastric_Bypass Exp_Lap-Trauma Vena_Cava_Filter Liver_Resection Subcu_Mastectomy Gastrostomy Pyloromyotomy Omphalocele_Repair
Level 3
Procedure: ____________________ Abdominal_Perineal_Resection Whipple
Other:
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