Internal Medicine Clerkship Logbook



No records returned.

Date Patient Seen:


Patient's Age:


Patient's Gender:

Type of Visit/)Problem:
Sick Patient - Acute
Sick Patient - Chronic
Follow-Up Visit
Health Maintenance 
Pre-Op Evaluation


Outpatient/Clinic Nursing Home
ER Out-Patient Surgery
Home Visit Other
In-Patient Standardized Patient/Computer-Based

Patient Category
(limit 2)

New acute condition or complaint (emphasis on diagnosis)

Chronic condition (emphasis on management)

Exacerbation of chronic condition (emphasis on management)

Asymptomatic patient (preventive case and screening)

Patient with limited access to care:  low-income, transportation problems, homebound, poor social circumstance, etc.

Diagnosis 1:

Organ System

Diagnosis 1

Diagnosis 2:
Organ System
Diagnosis 2
Diagnosis 3:
Organ System
Diagnosis 3
Diagnosis 4:
Organ System
Diagnosis 4
Diagnosis 5:
Organ System
Diagnosis 5
Diagnosis 6:
Organ System
Diagnosis 6
*None ID Injection Stool Guaiac
*Other IM Injection Thoracentesis
Arterial Puncture IV Start Tonometry Exam
Bladder Catheterization Lumbar Puncture Urinalysis
Bone Marrow NG Intubation Venipuncture
CPR Paracentesis  
History and Physical
 Procedure Role:




Medical Errors:



Problems with any entries?  Contact Jean Afflerbach

Copyright © 2013 Board of Trustees, Southern Illinois University

Revised: January 15, 2015