ChecklistTemplateVersions ChecklistTemplateVersion Ckey OfficialName VisibleText RevisionDate Checklist; Adrenal gland: 16.1000043 Resection Adrenal gland: Checklist; Ampulla of 17.1000043 Vater: Ampullectomy Ampulla of Vater: Ampullectomy 1/1/2005 Checklist; Ampulla of Vater: 18.1000043 Pancreaticoduodenectomy Ampulla of Vater: Pancreaticoduodenectomy 1/1/2005 Checklist; Anus: Excisional 19.1000043 Biopsy Anus: Excisional Biopsy 1/1/2005 Checklist; Anus: Local Excision (Transanal Disk 20.1000043 Excision) Anus: Local Excision (Transanal Disk Excision) 1/1/2005 21.1000043 Checklist; Anus: Resection Anus: Checklist; Appendix: 85.1000043 Resection Appendix: Resection 7/1/2006 104.1000043 Checklist; Bone Biopsy Bone Biopsy 7/1/2006 26.1000043 Checklist; Bone Marrow: Blood Film, Aspirate, Cell Block, Trephine Biopsy, Touch Imprint Bone Marrow: Blood Film, Aspirate, Cell Block, Trephine Biopsy, Touch Imprint 1/1/2005 101.1000043 Checklist; Bone Resection Bone Resection 7/1/2006
Checklist; Brain/Spinal 27.1000043 Cord: Biopsy/Resection 118.1000043 Checklist; Breast: Excision Less Than Total Mastectomy (Includes Wire Guided Localization Excisions); Total Mastectomy, Modified Radical Mastectomy, Radical Mastectomy Checklist; Breast: Excision Less Than Total Mastectomy (Includes Wire Guided Localization Excisions); Total Mastectomy, Modified Radical Mastectomy, 1.1000043 Radical Mastectomy Checklist; Colon and Rectum: Excisional Biopsy 29.1000043 (Polypectomy) Checklist; Colon and Rectum: Excisional Biopsy 114.1000043 (Polypectomy) Checklist; Colon and Rectum: Excisional Biopsy 115.1000043 (Polypectomy) Checklist; Colon and 31.1000043 Rectum: Resection Checklist; Colon and 116.1000043 Rectum: Resection Brain/Spinal Cord: Biopsy/ Breast CS2 DRAFT: Excision Less Than Total Mastectomy (Includes Wire Guided Localization Excisions); Total Mastectomy, Modified Radical Mastectomy, Radical Mastectomy 6/15/2007 Breast: Excision Less Than Total Mastectomy (Includes Wire Guided Localization Excisions); Total Mastectomy, Modified Radical Mastectomy, Radical Mastectomy 1/1/2005 Colon and Rectum: Excisional Biopsy (Polypectomy) 1/1/2005 Colon and Rectum: Excisional Biopsy (Polypectomy) 6/6/2007 Colon and Rectum: Excisional Biopsy (Polypectomy) CS2 DRAFT 6/12/2007 Colon and Rectum: Colon and Rectum: Resection CS2 DRAFT 6/12/2007
Checklist; Endometrium: 32.1000043 Biopsy Endometrium: Biopsy 1/1/2005 33.1000043 109.1000043 Checklist; Endometrium: Tissues Checklist; Endometrium: Tissues Endometrium: Tissues 1/1/2005 Endometrium: Tissues 7/31/2007 Checklist; Endometrium: 117.1000043 Tissues Endometrium: Tissues CS2 DRAFT 6/15/2007 Checklist; Esophagus: 34.1000043 Biopsy Esophagus: Biopsy 1/1/2005 Checklist; Esophagus: 35.1000043 Resection Esophagus: Checklist; Extrahepatic Bile Extrahepatic Bile Ducts: 36.1000043 Ducts: Resection 56.1000043 Checklist; Fallopian Tube: Unilateral Salpingectomy, Fallopian Tube: Unilateral Salpingectomy, Salpingooophorectomy, or Salpingo oophorectomy, or Hysterectomy with Salpingo oophorectomy Hysterectomy with Salpingo oophorectomy 1/1/2005
57.1000043 Checklist; Gallbladder: Resection/Cholecystectom y Gallbladder: Resection/Cholecystectom y 1/1/2005 58.1000043 Checklist; Gastrointestinal Lymphoma: Resection Gastrointestinal Lymphoma: 59.1000043 108.1000043 60.1000043 Checklist; Heart: Resection Heart: Checklist; Hepatoblastoma Hepatoblastoma 4/1/2007 Checklist; Hodgkin Lymphoma: Biopsy/Staging Procedure Hodgkin Lymphoma: Biopsy/Staging py gprocedure 1/1/2005 61.1000043 Checklist; Kidney: Biopsy Kidney: Biopsy 1/1/2005 Checklist; Kidney: Nephrectomy, Partial or 62.1000043 Radical Kidney: Nephrectomy, Partial or Radical 1/1/2005 63.1000043 Checklist; Liver: Resection Liver: 64.1000043 Checklist; Lung: Biopsy Lung: Biopsy 1/1/2005 120.1000043 Checklist; Lung: Biopsy Lung: Biopsy CS2 DRAFT 7/31/2007 65.1000043 Checklist; Lung: Resection Lung:
119.1000043 Checklist; Lung: Resection Lung: Resection CS2 DRAFT 7/31/2007 44.1000043 Checklist; Major Salivary Glands: Resection Major Salivary Glands: Checklist; Neuroblastoma: 76.1000043 Resection Neuroblastoma: Resection 7/1/2005 Checklist; Non Hodgkin Lymphoma: Biopsy, 66.1000043 Resection Non Hodgkin Lymphoma: Biopsy, Checklist; Ovary: Oophorectomy, Salpingooophorectomy, Subtotal Oophorectomy or Removal of Tumor in Fragments, Hysterectomy with 67.1000043 Salpingo oophorectomy Checklist; Pancreas (Endocrine): Excisional Biopsy (Enucleation), 68.1000043 Resection Checklist; Pancreas 69.1000043 (Exocrine): Resection 70.1000043 Ovary: Oophorectomy, Salpingo oophorectomy, Subtotal Oophorectomy or Removal of Tumor in Fragments, Hysterectomy with Salpingooophorectomy 1/1/2005 Pancreas (Endocrine): Excisional Biopsy (Enucleation), Pancreas (Exocrine): Checklist; Peritoneum: Resection Peritoneum:
Checklist; 49.1000043 Pleura/Pericardium: Biopsy Pleura/Pericardium: Biopsy 1/1/2005 Checklist; Pleura/Pericardium: 83.1000043 Resection Pleura/Pericardium: Checklist; Primitive Neuroectodermal Tumor / 77.1000043 Ewing Sarcoma: Resection Checklist; Prostate Gland: 78.1000043 Needle Biopsy Checklist; Prostate Gland: Needle Biopsy, py Transurethral Prostatic Resection (TUR), 71.1000043 Enucleation Specimen Primitive Neuroectodermal Tumor / Ewing: Prostate Gland: Needle Biopsy 7/1/2006 Prostate Gland: Needle Biopsy, Transurethral Prostatic Resection (TUR), Enucleation Specimen 1/1/2005 72.1000043 80.1000043 79.1000043 30.1000043 Checklist; Prostate Gland: Radical Prostatectomy Checklist; Prostate Gland: Radical Prostatectomy Checklist; Prostate Gland:Transurethral Prostatic Resection (TUR), Enucleation Specimen Checklist; Rectum: Local Excision (Transanal Disk Excision) Prostate Gland: Radical Prostatectomy 1/1/2005 Prostate Gland: Radical Prostatectomy 7/1/2006 Prostate Gland:Transurethral Prostatic Resection (TUR), Enucleation Specimen 7/1/2006 Rectum: Local Excision (Transanal Disk Excision) 1/1/2005
24.1000043 73.1000043 Checklist; Renal pelvis: Resection/Nephroureterec tomy, Partial or Complete Checklist; Retinoblastoma: Enucleation, Partial or Complete Exenteration Checklist; Rhabdomyosarcoma and Related Neoplasms: Excision, Local or Wide; Compartmentectomy; Excision, Radical; 75.1000043 Amputation; Other 74.1000043 55.1000043 121.1000043 Renal pelvis: Resection/Nephroureterec tomy, Partial or Complete 1/1/2005 Retinoblastoma: Enucleation, Partial or Complete Exenteration 1/1/2005 Rhabdomyosarcoma and Related Neoplasms: Excision, Local or Wide; Compartmentectomy; Excision, Radical; Amputation; Other 1/1/2005 Checklist; Carcinoma of the Skin: Resection Skin Carcinoma: Checklist; Melanoma of the Skin Melanoma: Excision; Skin: Excision; Re Excision Re Excision 1/1/2005 Checklist; Melanoma of the Skin Melanoma: Excision; Skin: Excision; Re Excision Re Excision CS2 DRAFT 7/31/2007 54.1000043 Checklist; Small Intestine: Polypectomy, Segmental Resection, Pancreaticoduodenectomy, Partial or Complete, With or Without Partial Gastrectomy (Whipple Resection) Small Intestine: Polypectomy, Segmental Resection, Pancreaticoduodenectomy, Partial or Complete, With or Without Partial Gastrectomy (Whipple Resection) 1/1/2005
Checklist; Soft Tissue 106.1000043 Biopsy Soft Tissue Biopsy 7/1/2006 Checklist; Soft Tissue 107.1000043 Resection Soft Tissue Resection 7/1/2006 52.1000043 Checklist; Stomach: Biopsy Stomach: Biopsy 1/1/2005 Checklist; Stomach: 53.1000043 Resection Stomach: Checklist; Testis: Radical 50.1000043 Orchiectomy Testis: Radical Orchiectomy 1/1/2005 Checklist; Testis: Retroperitoneal 51.1000043 Lymphadenectomy Testis: Retroperitoneal Lymphadenectomy 1/1/2005 Checklist; Thymoma and 47.1000043 Thymic Carcinoma: Biopsy Thymoma and Thymic Carcinoma: Biopsy 1/1/2005 Checklist; Thymoma and Thymic Carcinoma: Thymectomy, Other 48.1000043 Procedure Thymoma and Thymic Carcinoma: Thymectomy, Other Procedure 1/1/2005 Checklist; Thyroid: 46.1000043 Resection Thyroid: Checklist; Thyroid: 81.1000043 Resection Thyroid: Resection 7/1/2006 Checklist; Trophoblast: Dilation and 45.1000043 Curettage/Resection Trophoblast: Dilation and Curettage /
Checklist; Upper Aerodigestive Tract and Minor Salivary Glands: Incisional and Excisional 43.1000043 Biopsy/Resection 25.1000043 22.1000043 Upper Aerodigestive Tract and Minor Salivary Glands: Incisional and Excisional Biopsy/ Checklist; Ureter: Resection Ureter: Checklist; Urinary bladder, Urinary Bladder, Ureter, Ureter, Renal Pelvis: Biopsy Renal Pelvis: Biopsy 1/1/2005 Checklist; Urinary bladder: Cystectomy, Partial, Total, or Radical; Anterior 23.1000043 Exenteration Checklist; Uterine Cervix: Colpectomy, Hysterectomy, Pelvic 42.1000043 Exenteration Checklist; Uterine Cervix: 41.1000043 Cone Biopsy Checklist; Uveal 37.1000043 Melanoma: Resection Urinary Bladder: Cystectomy, Partial, Total, or Radical; Anterior Exenteration 1/1/2005 Uterine Cervix: Colpectomy, Hysterectomy, Pelvic Exenteration 1/1/2005 Uterine Cervix: Cone Biopsy 1/1/2005 Uveal Melanoma: 39.1000043 Checklist; Vagina: Biopsy Vagina: Biopsy 1/1/2005 Checklist; Vagina: Excisional Biopsy, 40.1000043 Resection Vagina: Excisional Biopsy,
Checklist; Vulva: Excisional 38.1000043 Biopsy/Resection 87.1000043 Vulva: Excisional Biopsy/ Checklist; Kidney: Resection for Wilms Tumor Wilms Tumor: