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: September 06, 2012