Y1 Mentor Log

Y1 Mentor Log (CRR)

Student Name:
Date:	MM/DD/YY
Name of Physician/Mentor
Specialty
Length of Visit (in hours)
Type of Experience
Patient Age
Patient Race:
Patient Gender:
Primary Diagnosis:
Procedure:
Observed or Participated?
Learning issues generated for further study:

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Jean Afflerbach (Web Master)

Page last updated Wednesday April 02, 2008