SIUSOM Year Two Logbook

Year Two Clinical Encounter Logbook

Name:

Date:

Patient:

Age: Gender:

Setting:

Mentor:

Hours:

Diagnosis 1:

Organ System
Diagnosis 1

Diagnosis 2:

Organ System
Diagnosis 2

Diagnosis 3:

Organ System
Diagnosis 3

Procedure:
(to select more than one item, click on
each item while holding down the
<control> key)

Procedure Role:

Problem List:

Comments:

Problems with any entries? Contact Jean Afflerbach

Revised: April 11, 2013