FAMILY & COMMUNITY MEDICINE/RADIOLOGY ELECTIVE LOGBOOK

Student Name:

Class:

Elective:

If Extramural or IDE, enter identifying information here:

Elective End Week:
Age:

Patient's Gender:

Type of Problem:

Location: 

Chief Complaint:
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Diagnosis:
Diagnosis 2:
Diagnosis 3:

Type of Visit: 

Procedure:
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Procedure Role: 

Problem List: 

Notes/Comments: 

 

 Contact us: Harald Lausen, DO (Curriculum Information)
Jean Afflerbach (Web Master)

Page last updated Monday July 08, 2013