Chris Hani Baragwanath Academic Hospital Please enable JavaScript in your browser to complete this form.Please enable JavaScript in your browser to complete this form.Scholar's Last Name *Scholar's First Name *Procedure Date *Patient Initials *Patient ID *Patient Date of Birth *Patient Gender *MaleFemaleOtherPatient Priority *Urgent – P1Emergency – P2Semi-electiveOrdinaryAnaesthesia *Rapid Sequence Induction and IntubationGeneral AnaesthesiaEpiduralParaspinalSubcostalRegionalLocalInvolvement *Primary SurgeonFirst AssistantSecond AssistantObserverProcedure *Max: 200 CharactersHospital *Johannesburg General HospitalChris Hani Baragwanath Academic HospitalNetcare Milpark HospitalOtherSpecifically *Other Participants *Supervising Surgeon (Present but not scrubed)Primary SurgeonFirst AssistantSecond AssistantSupervising Surgeon's name: *Primary Surgeon's name: *First Assistant's name: *Second Assistant's name: *Specific Skill/Knowledge/Experience AcquiredSUBMIT
