Case Log Sheet
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1American College of Mohs Surgery
American College of Mohs Surgery
American College of Mohs Surgery
American College of Mohs Surgery
Case Log
Physician Name: __________________________
For Training Program/FIT Use
Case
Date
Diagnosis/
Primary/
Location
Pre-Op
Post-Op
# of Stages Type of Repair
Complex
Supervising
Fellow Role
Case
Faculty
Primary/Assisting
Histology
Recurrent
Size
Size
Number
(Y/N)
(P/R)
(P/A)
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
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Parent category: Miscellaneous