You can print this template, photocopy it, and bind it into a logbook. Ensure you use and no white-out (errors must be single-striked, initialed, and dated). DHA Surgical Logbook Template (Paper Version) Surgeon Name: ________________________ DHA License No. (if any): ________________________ Specialty: ________________________ (e.g., General Surgery, Ortho, OB/GYN) Hospital/Facility: ________________________ Logbook Period: From ________ / ________ / ________ to ________ / ________ / ________
________________________ Date: ________
| | Date (DD/MM/YYYY) | Patient Initials (MRN optional) | Procedure Name (Use official terminology) | Side (R/L/Bilateral) | Approach (Open/Lap/Endo/Robotic) | Surgeon Role (Chief, First Assist, Supervising, Observed) | Complexity (Minor/Major/Complex) | Complications (None / Intra-op / Post-op - specify) | Supervising Consultant Signature & DHA License # | | :--- | :--- | :--- | :--- | :--- | :--- | :--- | :--- | :--- | :--- | | 1 | | | | | | | | | | | 2 | | | | | | | | | | | 3 | | | | | | | | | | | 4 | | | | | | | | | | | 5 | | | | | | | | | | | 6 | | | | | | | | | | | 7 | | | | | | | | | | | 8 | | | | | | | | | | | 9 | | | | | | | | | | | 10 | | | | | | | | | | | (Continue on additional sheets) | | | | | | | | | | Required Summary Page (End of Logbook) Total Major Cases: ________ Total Minor Cases: ________ Total as Primary Surgeon (Chief): ________ Total as First Assist: ________
You can print this template, photocopy it, and bind it into a logbook. Ensure you use and no white-out (errors must be single-striked, initialed, and dated). DHA Surgical Logbook Template (Paper Version) Surgeon Name: ________________________ DHA License No. (if any): ________________________ Specialty: ________________________ (e.g., General Surgery, Ortho, OB/GYN) Hospital/Facility: ________________________ Logbook Period: From ________ / ________ / ________ to ________ / ________ / ________
________________________ Date: ________
| | Date (DD/MM/YYYY) | Patient Initials (MRN optional) | Procedure Name (Use official terminology) | Side (R/L/Bilateral) | Approach (Open/Lap/Endo/Robotic) | Surgeon Role (Chief, First Assist, Supervising, Observed) | Complexity (Minor/Major/Complex) | Complications (None / Intra-op / Post-op - specify) | Supervising Consultant Signature & DHA License # | | :--- | :--- | :--- | :--- | :--- | :--- | :--- | :--- | :--- | :--- | | 1 | | | | | | | | | | | 2 | | | | | | | | | | | 3 | | | | | | | | | | | 4 | | | | | | | | | | | 5 | | | | | | | | | | | 6 | | | | | | | | | | | 7 | | | | | | | | | | | 8 | | | | | | | | | | | 9 | | | | | | | | | | | 10 | | | | | | | | | | | (Continue on additional sheets) | | | | | | | | | | Required Summary Page (End of Logbook) Total Major Cases: ________ Total Minor Cases: ________ Total as Primary Surgeon (Chief): ________ Total as First Assist: ________ surgical logbook template for dha