Sample Case Log

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There is also a version of this log, with identical content, in Excel format.)

For Physicians who completed 12 month clinical fellowship dedicated to the
perioperative care of surgical patients with cardiovascular disease or
who are using Supervised Training Pathway (Requirement 5)

Supervised Training
Perioperative Transesophageal Echocardiography
Examinations Studied but NOT performed

Physician's Full Name _______________________________________________________________

Physician's Date of Birth _____________________________________________________________

Physician's Social Security Number _____________________________________________________