MHMC Resident Procedure Record

Resident First Name:       [FirstName]
Resident Last Name:        [LastName]
Resident Email:            [resemail]
Year:                      [Year]

Medicine Procedure:        [Medicine]
Pediatric Procedure:       [Pediatrics]

Date:                      [Date]
Supervisor:                [Supervisor]
Patient's Location:        [PLocation]
Patient's First Name:      [PFirstName]
Patient's Last Name:       [PLastName]
Patient's MHMC #:          [PNumber]

Procedure Location:        [Location]
Procedure Indication:      [Indication]

Procedure Complications:
        [Complications]
Procedure Comments:
        [Comments]

If you have any questions about this record, please contact David Kaelber,
MD/PhD at dck3@po.cwru.edu.