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Manual for Male Circumcision under Local Anaesthesia

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<strong>Male</strong> circumcision <strong>under</strong> local anaesthesia<br />

Version 3.1 (Dec09)<br />

Appendix 9.4<br />

SAMPLE MALE CIRCUMCISION REGISTER<br />

Date<br />

(dd/mm/yy)<br />

Patient ID<br />

number (from<br />

card)<br />

Surname<br />

Given<br />

name(s)<br />

Age<br />

Procedure<br />

Type of<br />

anaesthesia<br />

Start<br />

time<br />

End time<br />

Surgeon’s<br />

name<br />

Nurse’s<br />

name<br />

Comments or<br />

notes<br />

Record keeping, monitoring, evaluation and supervision Chapter 9-15

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