Below is the definitive template structure. Each column must be clearly labeled, and no field should be left blank. If data is unavailable, use “N/A” with a footnote.

| Field # | Field Name | Description & DHA Requirement | |-------------|----------------|------------------------------------| | 1 | Date of Procedure | DD/MM/YYYY format. No gaps in chronology longer than 3 months without explanation. | | 2 | Patient Identifier | Anonymized (e.g., MRN: 12345 or Initials: A.B.). Never include full name or passport number due to privacy laws (DHA Health Data Protection Regulation). | | 3 | Patient Age & Gender | Age in years (or months for pediatrics) and M/F/Other. Essential for risk adjustment. | | 4 | Preoperative Diagnosis | ICD-10 code + brief text. Example: K35.80 – Acute appendicitis. | | 5 | Procedure Name | Exact, standardized terminology (preferably CPT or SNOMED CT). Avoid slang. Example: Laparoscopic cholecystectomy – not “lap chole.” | | 6 | CPT/Procedure Code | Current Procedural Terminology (CPT) or local DHA-approved coding system. | | 7 | Laterality | Left / Right / Bilateral / N/A. Crucial for orthopedics, ophthalmology, ENT. | | 8 | Urgency | Elective / Emergency / Urgent. Differentiates planned from high-acuity cases. | | 9 | ASA Class | American Society of Anesthesiologists Physical Status (1 to 6). Mandatory for risk stratification. | | 10 | Role of Surgeon | Chief Surgeon (primary operator) / Co-surgeon / Supervising Consultant / Teaching Assistant / First Assist. DHA distinguishes these strictly. | | 11 | Supervising Consultant (if trainee) | Full name and DHA license number of the responsible senior. For independent practitioners, write “Independent.” | | 12 | Surgical Approach | Open / Laparoscopic / Robotic / Endoscopic / Percutaneous. | | 13 | Anesthesia Type | General / Regional / Local with sedation / MAC (Monitored Anesthesia Care). | | 14 | Operative Time | Skin-to-skin or incision-to-closure time (minutes). Helps assess efficiency and complexity. | | 15 | Blood Loss | Estimated (mL). For major procedures, document as <500, 500-1000, >1000 mL. | | 16 | Intraoperative Complications | Yes/No – if yes, describe (e.g., bowel injury, bleeding requiring transfusion). | | 17 | Postoperative Complications | Clavien-Dindo grade (I to V) + description within 30 days. Zero complications must be stated as “None.” | | 18 | Length of Stay | Total hospital days post-surgery. | | 19 | Discharge Status | Home / Rehabilitation / Other hospital / Death. | | 20 | Reoperation within 30 days? | Yes/No – if yes, reason (e.g., bleeding, wound dehiscence). | | 21 | Hospital/Facility Name | Where procedure was performed (DHA-licensed facility). | | 22 | Verification Signature | Digital or wet signature of the surgeon. For trainees, countersignature of supervising consultant is required every 10-20 cases. |

The final page of the logbook must contain a self-attestation statement signed and dated by the surgeon. Recommended wording:

“I, [Full Name], DHA License No. [if applicable], hereby certify that this surgical logbook is a true, accurate, and complete record of all operative procedures performed by me during the period from [start date] to [end date]. I understand that any falsification may result in rejection of my application or disciplinary action by the Dubai Health Authority.”

For logbooks submitted as part of initial licensure or privileging, the DHA may require additional verification from the Chief of Surgery or Medical Director of the primary facility where cases were performed – typically via a cover letter or stamp on the summary page.

Add a third tab with the following legal text, dated and signed:

“I, [Your Name], hereby declare that this surgical logbook is a true and accurate record of my operative experience. I understand that falsification of this document will lead to permanent disqualification from DHA licensing.”

Then add countersignature from your current Medical Director or Head of Department (with stamp).

You must state your exact role:

Note: For most DHA consultant applications, 70% of cases must list the applicant as Primary Surgeon.