Pediatrics Patient Encounter Elective Logbook

Student Name:

Class:

Elective:

If Extramural or IDE, enter identifying information here:

Elective End Week:

Date Patient Seen:

Patient's Age:

Patient's Gender:

Location: 
Discipline:
Primary Diagnosis: 

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

Procedure:

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

Procedure Role:

Management Plan:

Problem List:

Notes/Comments:

  


Jean Afflerbach, Web Master
Revised: July 08, 2013