Y1 Field/Elective Log

Student Name:
Date of Encounter	mm/dd/yy
Name of Facility
Who was your supervising clinician/staff (last name, first initial)?
Describe the experience and evaluate its worth to you.
This experience was a good use of my time.		Yes No
I would recommend this experience for others.		Yes No
Was this a required clinical field experience or an elective experience?		Required Elective

Y1 Field/Elective Log (ERG)