Case Log Form

Please submit a Case Load Summary Chart below for 2015-2016 year for the Program Director as there are no prior current fellows.

Program Director Name*
First Last
Program Name
Name of Person Filling Out this Form
Reply Email*
Please report the total number of cases performed (including open and minimally-invasive cases) in the categories specified below
Total # of operative surgical procedures performed as primary surgeon per Fellow*
Bariatric Colorectal General HPB Solid Organ Foregut Thoracic Open GI/General Other
Total # of operative surgical procedures performed as 1st assistant per Fellow*
Bariatric Colorectal General HPB Solid Organ Foregut Thoracic Open GI/General Other
Total # of operative surgical procedures performed as teaching assistant per Fellow*
Bariatric Colorectal General HPB Solid Organ Foregut Thoracic Open GI/General Other
Of the total number of cases reported in the chart above, please report the number of cases performed minimally-invasive in each of the categories indicated below (the number of cases entered here should be less than or equal to the number of cases entered for total in each category)
Total # of Minimally Invasive operative Surgical procedures performed as primary surgeon per Fellow*
Bariatric Colorectal General HPB Solid Organ Foregut Thoracic Other
Total # of Minimally Invasive operative Surgical procedures performed as 1st assistant per Fellow*
Bariatric Colorectal General HPB Solid Organ Foregut Thoracic Other
Total # of Minimally Invasive operative surgical procedures performed as teaching assistant per Fellow*
Bariatric Colorectal General HPB Solid Organ Foregut Thoracic Other
It is certified by marking this box that the case numbers submitted in this chart have been tabulated and reviewed by the Program Director for final approval and accuracy.*
- The above chart is accurate
Comments regarding the grid above: (100 words or less)

Please submit a Case Load Summary Chart below for 2015-2016 year for the Program Director as there are no prior current fellows.

Please report the total number of cases performed (including open and minimally-invasive cases) in the categories specified below

Of the total number of cases reported in the chart above, please report the number of cases performed minimally-invasive in each of the categories indicated below (the number of cases entered here should be less than or equal to the number of cases entered for total in each category)