Orthopedic 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: ____________________ Closed_Reduction_-Manipulation- External_Fixation Achilles_Tendon_Repair Tendon-Nerve_Repair Carpal_Tunnel_Release Trigger_Finger_Release Bone_Spur Removal_of_Hardware Osteotomy Debridment
Level 2
Procedure: ____________________ Bunionectomy Ganglion_Cyst ORIF-Plates, Screws,Rods,Pins:Humerus ORIF-Plates, Screws,Rods,Pins: Ulna/Radius ORIF-Plates, Screws,Rods,Pins: Wrist ORIF-Plates, Screws,Rods,Pins: Hand/Fingers ORIF-Plates, Screws,Rods,Pins: Hip ORIF-Plates, Screws,Rods,Pins: Femur ORIF-Plates, Screws,Rods,Pins: Tibia/Fibula ORIF-Plates, Screws,Rods,Pins: Ankle ORIF-Plates, Screws,Rods,Pins: Foot/Toes ORIF_Calcaneous Lumbar_Laminectomy/Fusion/Fixation IM Rod Arthroscopy-Knee Arthroscopy-Elbow Arthroscopy-Shoulder Arthroscopy-Ankle Rotator_Cuff_Repair Patellectomy Excision_Bone_Tumor Ligament_Repair Arthrodesis Laminectomy:_Lumbar Laminectomy:_Anterior_Cervical Laminectomy:_Posterior_Cervical Laminectomy:Thoracic
Level 3
Procedure: ____________________ ORIF-Clavicle Total_Joint_Replacement: Hip Total_Joint_Replacement: Knee Total_Joint_Replacement: Shoulder
Other:
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