EAST AVENUE MEDICAL CENTER

DEPARTMENT OF SURGERY

INTERN’S PROCEDURES CHECKLIST

NAME: ____________________________________________________________ BLOCK: _____

PERIOD OF ROTATION: ___________________________

A. MAJOR PROCEDURES

DATE: DATE:

PROCEDURE: PROCEDURE:

RESIDENT ASSISTED (TRODAT AND SIGNATURE): RESIDENT ASSISTED (TRODAT AND SIGNATURE):

REMARKS: REMARKS:

DATE: DATE:

PROCEDURE: PROCEDURE:

RESIDENT SURGEON ASSISTED (TRODAT AND SIGNATURE): RESIDENT SURGEON ASSISTED (TRODAT AND SIGNATURE):

REMARKS: REMARKS:

DATE: DATE:

PROCEDURE: PROCEDURE:

RESIDENT ASSISTED (TRODAT AND SIGNATURE): RESIDENT ASSISTED (TRODAT AND SIGNATURE):

REMARKS: REMARKS:

DATE: DATE:

PROCEDURE: PROCEDURE:

RESIDENT ASSISTED (TRODAT AND SIGNATURE): RESIDENT ASSISTED (TRODAT AND SIGNATURE):

REMARKS: REMARKS:

DATE: DATE:

PROCEDURE: PROCEDURE:

RESIDENT ASSISTED (TRODAT AND SIGNATURE): RESIDENT ASSISTED (TRODAT AND SIGNATURE):

REMARKS: REMARKS:
 EAST AVENUE MEDICAL CENTER
DEPARTMENT OF SURGERY

B. MINOR PROCEDURES

DATE: DATE:

PROCEDURE: PROCEDURE:

RESIDENT ASSISTED (TRODAT AND SIGNATURE): RESIDENT ASSISTED (TRODAT AND SIGNATURE):

REMARKS: REMARKS:

DATE: DATE:

PROCEDURE: PROCEDURE:

RESIDENT SURGEON ASSISTED (TRODAT AND SIGNATURE): RESIDENT SURGEON ASSISTED (TRODAT AND SIGNATURE):

REMARKS: REMARKS:

DATE: DATE:

PROCEDURE: PROCEDURE:

RESIDENT ASSISTED (TRODAT AND SIGNATURE): RESIDENT ASSISTED (TRODAT AND SIGNATURE):

REMARKS: REMARKS:

C. BEDISDE PROCEDURES

DATE: DATE:

PROCEDURE: PROCEDURE:

RESIDENT ASSISTED (TRODAT AND SIGNATURE): RESIDENT ASSISTED (TRODAT AND SIGNATURE):

REMARKS: REMARKS:

DATE: DATE:

PROCEDURE: PROCEDURE:

RESIDENT SURGEON ASSISTED (TRODAT AND SIGNATURE): RESIDENT SURGEON ASSISTED (TRODAT AND SIGNATURE):

REMARKS: REMARKS:

DATE: DATE:

PROCEDURE: PROCEDURE:

RESIDENT ASSISTED (TRODAT AND SIGNATURE): RESIDENT ASSISTED (TRODAT AND SIGNATURE):

REMARKS: REMARKS:
 EAST AVENUE MEDICAL CENTER
DEPARTMENT OF SURGERY

D. HISTORY AND PHYSICAL EXAMINATION

PATIENT’ S INITIAL: PATIENT’ S INITIAL:

CASE: CASE:

PROCEDURE DONE: PROCEDURE DONE:

RESIDENT ASSISTED (TRODAT AND SIGNATURE): RESIDENT ASSISTED (TRODAT AND SIGNATURE):

REMARKS: REMARKS:

PATIENT’ S INITIAL: PATIENT’ S INITIAL:

CASE: CASE:

PROCEDURE DONE: PROCEDURE DONE:

RESIDENT ASSISTED (TRODAT AND SIGNATURE): RESIDENT ASSISTED (TRODAT AND SIGNATURE):

REMARKS: REMARKS:

PATIENT’ S INITIAL: PATIENT’ S INITIAL:

CASE: CASE:

PROCEDURE DONE: PROCEDURE DONE:

RESIDENT ASSISTED (TRODAT AND SIGNATURE): RESIDENT ASSISTED (TRODAT AND SIGNATURE):

REMARKS: REMARKS:
 EAST AVENUE MEDICAL CENTER
DEPARTMENT OF SURGERY

INTERNS’ ATTENDANCE

NAME: ___________________________________ DATE OF ROTATION: ______________________________

TEAM: ___________________________________

MONDAY TUESDAY WEDNESDAY THURSDAY FRIDAY SATURDAY SUNDAY

Date : _______ Date: _______ Date: _______ Date: _______ Date: _______ Date: _______ Date: _______
GS: _______ GS: _______ GS: _______ GS: _______ GS: _______ GS: _______ GS: _______
Post: _______ Post: _______ Post: _______ Post: _______ Post: _______ Post: _______ Post: _______

Resident’s Resident’s Resident’s Resident’s Resident’s Resident’s Resident’s

signature/trodat: signature/trodat: signature/trodat: signature/trodat: signature/trodat: signature/trodat: signature/trodat:

Date: _______ Date: _______ Date: _______ Date: _______ Date: _______ Date: _______ Date: _______
GS: _______ GS: _______ GS: _______ GS: _______ GS: _______ GS: _______ GS: _______
Post: _______ Post: _______ Post: _______ Post: _______ Post: _______ Post: _______ Post: _______

Resident’s Resident’s Resident’s Resident’s Resident’s Resident’s Resident’s

signature/trodat: signature/trodat: signature/trodat: signature/trodat: signature/trodat: signature/trodat: signature/trodat:

Date: _______ Date: _______ Date: _______ Date: _______ Date: _______ Date: _______ Date: _______
GS: _______ GS: _______ GS: _______ GS: _______ GS: _______ GS: _______ GS: _______
Post: _______ Post: _______ Post: _______ Post: _______ Post: _______ Post: _______ Post: _______

Resident’s Resident’s Resident’s Resident’s Resident’s Resident’s Resident’s

signature/trodat: signature/trodat: signature/trodat: signature/trodat: signature/trodat: signature/trodat: signature/trodat:

Date: _______ Date: _______ Date: _______ Date: _______ Date: _______ Date: _______ Date: _______
GS: _______ GS: _______ GS: _______ GS: _______ GS: _______ GS: _______ GS: _______
Post: _______ Post: _______ Post: _______ Post: _______ Post: _______ Post: _______ Post: _______

Resident’s Resident’s Resident’s Resident’s Resident’s Resident’s Resident’s

signature/trodat: signature/trodat: signature/trodat: signature/trodat: signature/trodat: signature/trodat: signature/trodat: