Infant Male Circumcision Audit Proforma New User Password Name of Surgeon(Required) Dr.MissMr.Mrs.Ms.Mx.Prof.Rev. Prefix First Last Your Email Address(Required) Please Note: For each operator we require a clinical audit of procedure outcomes undertaken within the past 12 months Dates of Audit: All infant male circumcision performed:From(Required) DD slash MM slash YYYY To(Required) DD slash MM slash YYYY Fill in a number in each category (if there are no complications in a category insert 0)Total number of circumcisions performedTotal number of circumcisions performed(Required)Please enter a number greater than or equal to 0.Number of bleedsNumber of bleeds(Required)Please enter a number greater than or equal to 0.Requiring operation under general anaestheticRequiring operation under general anaesthetic(Required)Please enter a number greater than or equal to 0.Observation in hospital only no surgery necessaryObservation in hospital only no surgery necessary(Required)Please enter a number greater than or equal to 0.Number developing infectionsNumber developing infections(Required)Please enter a number greater than or equal to 0.Plastibell requiring removal (Loose)Plastibell requiring removal (Loose)(Required)Please enter a number greater than or equal to 0.Plastibell requiring removal (Stuck)Plastibell requiring removal (Stuck)(Required)Please enter a number greater than or equal to 0.Failed Plastibell at clinic and Sutures usedFailed Plastibell at clinic and Sutures used(Required)Please enter a number greater than or equal to 0.
