DNB (ORTHOPEDICS) Batch: 20-21 CLOSED REDUCTIONS AND OBSERVED/ASSISTED Apex/01/DNB/01 S. No. Date Patient Name IPD No. Diagnosis Procedure Signature of Faculty …………………………………………..… ……………………………………………………….. ………………………………………………………. (Signature of the Candidates) Signature of Head of the Department/ Signature with official stamp of Name ………………………………. Course Director with stamp of Administrative Head of the Institute/ Date………..… Time…….......... Anesthesia /Ortho Hospital (Authorized signatory on Designator……………………….. Behalf of applicant Hospital) DNB (ORTHOPEDICS ) Batch: 20-21 CLOSED REDUCTIONS DONE INDEPENDENTLY Apex/01/DNB/01 S. No. Date Patients Name IPD No. Diagnosis Procedure Signature of Faculty …………………………………………..… ……………………………………………………….. ………………………………………………………. (Signature of the Candidates) Signature of Head of the Department/ Signature with official stamp of Name ………………………………. Course Director with stamp Administrative Head of the Institute/ Date………..… Time…….......... of Anesthesia/Ortho Designator……………………… Hospital (Authorized signatory Behalf of applicant Hospital) DNB (ORTHOPEDICS ) Batch: 20-21 Orthosis, Prosthesis & Braces seen & Applied Apex/01/DNB/01 S. No. Date Patients Name IPD No. Diagnosis Gadgets Signature of Faculty …………………………………………..… ……………………………………………………….. ………………………………………………………. (Signature of the Candidates) Signature of Head of the Department/ Signature with official stamp of Name ………………………………. Course Director with stamp Administrative Head of the Institute/ Date………..… Time…….......... of Anesthesia/Ortho Hospital (Authorized signatory on Designator……………………… Behalf of applicant Hospital) DNB (ORTHOPEDICS ) Batch: 20-21 Minor Procedures Assisted/Observed Apex/01/DNB/01 (Aspirations, Tractions, Incision drainage, Arthrotomy, Implant Removal, Intra-articular Injections, Infiltration, Epidural Blocks, Infiltration, CLW repairs, Catheterizations, Dressing & Debridement’s etc). S. No. Date Patients Name IPD No. Diagnosis Procedure Signature of Faculty …………………………………………..… ……………………………………………………….. ………………………………………………………. (Signature of the Candidates) Signature of Head of the Department/ Signature with official stamp of Name ………………………………. Course Director with stamp Administrative Head of the Institute/ Date………..… Time…….......... of Anesthesia/Ortho Designator……………………….. Hospital (Authorized signatory on Behalf of applicant Hospital) DNB (ORTHOPEDICS ) Batch: 20-21 Minor Procedures Done Independently Apex/01/DNB/01 (Aspirations, Tractions, Incision drainage, Arthrotomy, Implant Removal, Intra-articular injections, Infiltration, Epidural Blocks, Infiltration, CLW Repairs, Catheterizations, Dressing & Debridement’s etc) S. No. Date Patients Name IPD No. Diagnosis Procedure Signature of Faculty …………………………………………..… ……………………………………………………….. ………………………………………………………. (Signature of the Candidates) Signature of Head of the Department/ Signature with official stamp of Name ………………………………. Course Director with stamp Administrative Head of the Institute/ Date………..… Time…….......... of Anesthesia/Ortho Hospital (Authorized signatory on Designator………………………. Behalf of applicant Hospital) DNB (ORTHOPEDICS ) Batch: 20-21 Orthosis, Prosthesis & Braces Seen & Applied Apex/01/DNB/01 S. No. Date Patients Name IPD No. Diagnosis Gadgets Signature of Faculty …………………………………………..… ……………………………………………………….. ………………………………………………………. (Signature of the Candidates) Signature of Head of the Department/ Signature with official stamp of Name ………………………………. Course Director with stamp Administrative Head of the Institute/ Date………..… Time…….......... of Anesthesia/Ortho Hospital (Authorized signatory on Designator……………………… Behalf of applicant Hospital) DNB (ORTHOPEDICS ) Batch: 20-21 Surgeries Observed/Assisted Apex/01/DNB/01 S .No. Date Patients Name IPD No. Diagnosis Procedure Sign. Of Faculty …………………………………………..… ……………………………………………………….. ………………………………………………………. (Signature of the Candidates) Signature of Head of the Department/ Signature with official stamp of Name ………………………………. Course Director with stamp Date………..… Time…….......... of Anesthesia/Ortho Designator……………………... Administrative Head of the Institute/ Hospital (Authorized signatory on Behalf of applicant Hospital) DNB (ORTHOPEDICS ) Batch: 20-21 Lectures/Seminars Attended Apex/01/DNB/01 S. No. Topic Signature of the faculty …………………………………………..… ……………………………………………………….. ………………………………………………………. (Signature of the Candidates) Signature of Head of the Department/ Signature with official stamp of Name ………………………………. Course Director with stamp Administrative Head of the Institute/ Date………..… Time…….......... of Anesthesia/Ortho Hospital (Authorized signatory on Designator………………………... Behalf of applicant Hospital) DNB (ORTHOPEDICS )Batch: 20-21 Seminars Presented Apex/01/DNB/01 S. No. Topic Assessment Signature of Moderator …………………………………………..… ……………………………………………………….. ………………………………………………………. (Signature of the Candidates) Signature of Head of the Department/ Signature with official stamp of Name ………………………………. Course Director with stamp Administrative Head of the Institute/ Date………..… Time…….......... of Anesthesia/Ortho Designator…………………….... Hospital (Authorized signatory on Behalf of applicant Hospital) DNB (ORTHOPEDICS ) Batch: 20-21 Presentation Attended In Journal Club Apex/01/DNB/01 S. No. Date Article Journal Signature of Moderator …………………………………………..… ……………………………………………………….. ………………………………………………………. (Signature of the Candidates) Signature of Head of the Department/ Signature with official stamp of Name ………………………………. Course Director with stamp Administrative Head of the Institute/ Date………..… Time…….......... of Anesthesia/Ortho Designator………….. ……. Hospital (Authorized signatory on Behalf of applicant Hospital) DNB (ORTHOPEDICS ) Batch: 20-21 CMEs Attended Apex/01/DNB/01 S. No. Date Topic Presented By Department Sing. Of Faculty …………………………………………..… ……………………………………………………….. ………………………………………………………. (Signature of the Candidates) Signature of Head of the Department/ Signature with official stamp of Name ………………………………. Course Director with stamp Administrative Head of the Institute/ Date………..… Time…….......... of Anesthesia/Ortho Hospital (Authorized signatory on Designator……………….……… Behalf of applicant Hospital) DNB (ORTHOPEDICS )Batch: 20-21 Clinical Cases Attended S. No. Date Patient Name IPD NO. Clinical cases Apex/01/DNB/01 Presenter Sign. Of Moderator …………………………………………..… ……………………………………………………….. ………………………………………………………. (Signature of the Candidates) Signature of Head of the Department/ Signature with official stamp of Name ………………………………. Course Director with stamp Administrative Head of the Institute/ Date………..… Time…….......... of Anesthesia/Ortho Hospital (Authorized signatory on Designator………………………. Behalf of applicant Hospital)
