Surgical Logbook

Chris Hani Baragwanath Academic Hospital

Scholar's Last Name *

Scholar's First Name *

Procedure Date *

Patient Initials *

Patient ID *

Patient Date of Birth *

Patient Gender *

• Male
• Female
• Other

Patient Priority *

• Urgent – P1
• Emergency – P2
• Semi-elective
• Ordinary

Anaesthesia *

• Rapid Sequence Induction and Intubation
• General Anaesthesia
• Epidural
• Paraspinal
• Subcostal
• Regional
• Local

Involvement *

• Primary Surgeon
• First Assistant
• Second Assistant
• Observer

Procedure *

Max: 200 Characters

Hospital *

• Johannesburg General Hospital
• Chris Hani Baragwanath Academic Hospital
• Netcare Milpark Hospital
• Other

Specifically *

Other Participants *

• Supervising Surgeon (Present but not scrubed)
• Primary Surgeon
• First Assistant
• Second Assistant

Supervising Surgeon's name: *

Primary Surgeon's name: *

First Assistant's name: *

Second Assistant's name: *

Specific Skill/Knowledge/Experience Acquired

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