IAC Cardiac Electrophysiology- Procedure Complication Log (Updated 5-2015) the Procedure

Cardiac Electrophysiology- Facility Procedure Log
Patient Name/ID DOB / Date of Procedure / Indication for the Procedure / Procedure Type / Operator:
Physician / Department or Specialty of Operator / Procedure Complication(s)
Cardiac Electrophysiology- Facility Procedure Log
Patient Name/ID DOB / Date of Procedure / Indication for the Procedure / Procedure Type / Operator:
Physician / Department or Specialty of Operator / Procedure Complication(s)
Cardiac Electrophysiology- Facility Procedure Log
Patient Name/ID DOB / Date of Procedure / Indication for the Procedure / Procedure Type / Operator:
Physician / Department or Specialty of Operator / Procedure Complication(s)
Cardiac Electrophysiology- Facility Procedure Log
Patient Name/ID DOB / Date of Procedure / Indication for the Procedure / Procedure Type / Operator:
Physician / Department or Specialty of Operator / Procedure Complication(s)
Cardiac Electrophysiology- Facility Procedure Log
Patient Name/ID DOB / Date of Procedure / Indication for the Procedure / Procedure Type / Operator:
Physician / Department or Specialty of Operator / Procedure Complication(s)
Cardiac Electrophysiology- Facility Procedure Log
Patient Name/ID DOB / Date of Procedure / Indication for the Procedure / Procedure Type / Operator:
Physician / Department or Specialty of Operator / Procedure Complication(s)
Cardiac Electrophysiology- Facility Procedure Log
Patient Name/ID DOB / Date of Procedure / Indication for the Procedure / Procedure Type / Operator:
Physician / Department or Specialty of Operator / Procedure Complication(s)
Cardiac Electrophysiology- Facility Procedure Log
Patient Name/ID DOB / Date of Procedure / Indication for the Procedure / Procedure Type / Operator:
Physician / Department or Specialty of Operator / Procedure Complication(s)
Cardiac Electrophysiology- Facility Procedure Log
Patient Name/ID DOB / Date of Procedure / Indication for the Procedure / Procedure Type / Operator:
Physician / Department or Specialty of Operator / Procedure Complication(s)
Cardiac Electrophysiology- Facility Procedure Log
Patient Name/ID DOB / Date of Procedure / Indication for the Procedure / Procedure Type / Operator:
Physician / Department or Specialty of Operator / Procedure Complication(s)
Cardiac Electrophysiology- Facility Procedure Log
Patient Name/ID DOB / Date of Procedure / Indication for the Procedure / Procedure Type / Operator:
Physician / Department or Specialty of Operator / Procedure Complication(s)
Cardiac Electrophysiology- Facility Procedure Log
Patient Name/ID DOB / Date of Procedure / Indication for the Procedure / Procedure Type / Operator:
Physician / Department or Specialty of Operator / Procedure Complication(s)
Cardiac Electrophysiology- Facility Procedure Log
Patient Name/ID DOB / Date of Procedure / Indication for the Procedure / Procedure Type / Operator:
Physician / Department or Specialty of Operator / Procedure Complication(s)
Cardiac Electrophysiology- Facility Procedure Log
Patient Name/ID DOB / Date of Procedure / Indication for the Procedure / Procedure Type / Operator:
Physician / Department or Specialty of Operator / Procedure Complication(s)
Cardiac Electrophysiology- Facility Procedure Log
Patient Name/ID DOB / Date of Procedure / Indication for the Procedure / Procedure Type / Operator:
Physician / Department or Specialty of Operator / Procedure Complication(s)
Cardiac Electrophysiology- Facility Procedure Log
Patient Name/ID DOB / Date of Procedure / Indication for the Procedure / Procedure Type / Operator:
Physician / Department or Specialty of Operator / Procedure Complication(s)
Cardiac Electrophysiology- Facility Procedure Log
Patient Name/ID DOB / Date of Procedure / Indication for the Procedure / Procedure Type / Operator:
Physician / Department or Specialty of Operator / Procedure Complication(s)
Cardiac Electrophysiology- Facility Procedure Log
Patient Name/ID DOB / Date of Procedure / Indication for the Procedure / Procedure Type / Operator:
Physician / Department or Specialty of Operator / Procedure Complication(s)
Cardiac Electrophysiology- Facility Procedure Log
Patient Name/ID DOB / Date of Procedure / Indication for the Procedure / Procedure Type / Operator:
Physician / Department or Specialty of Operator / Procedure Complication(s)
Cardiac Electrophysiology- Facility Procedure Log
Patient Name/ID DOB / Date of Procedure / Indication for the Procedure / Procedure Type / Operator:
Physician / Department or Specialty of Operator / Procedure Complication(s)

IAC Cardiac Electrophysiology- Procedure Complication Log (Updated 5-2015)
The procedure complication log is an individual log kept for each operator to document the outcomes, including complications, of the procedures that they have performed on individual patients. These logs will be requested at the time ofsite visit.