Surgery Clerkship Logbook
Name:

Surgeon:
Rotation:
Date Patient Seen:    

Meets requirements:   Yes     No    

Explanation of meets requirements.  'Yes' entries should only be included
when the following criteria are met:

 

Pre-op
Assessment

Participate
in Surgery

 Post-op
Assessment		 Daily
Progress

Outpatient

X

 X

 

  

Same Day Outpatient

 X X X X*

AM Admission

 X X X X

Inpatient

 X X X X

 *Inpatient counts only if patient remains in the hospital 2 days post-op.
Otherwise a same day outpatient counts as an outpatient.
Patient's Age:
Newborn (0-11 mo)
Pediatrics (1-12 years)
Adolescent (13-17 years)
Adult (18-64 years)
Geriatric (65+ years)

 

Patient's Gender:

 

Location: 

 

Chief Complaint:
*None fatigue painful limb
abdominal distention fever/chills paralysis
abdominal mass flank pain pelvic mass
abdominal pain fractures/dislocation/joint injuries renal failure acute or chronic
abnormal liver function tests gait disturbances rhinosinusitis
abnormality of the white blood cells gastroesophageal reflux scar revision
acute illness in an infant/child gastrointestinal bleeding scrotal mass/pain
anemia head injury/brain death/transplant donation seizures
back pain headache shock/hypotension
bleeding tendency/bruising hearing loss/deafness skin lesions
breast disorders hematemesis sleep disturbances
burns hematuria sore throat
cardiac arrest/respiratory arrest hemoptysis spinal injuries
chest discomfort/Angina pectori hemorrhoids/rectal mass splenamegaly
colon polyps hernia syncope
colonoscopy/routine screening impaired consciousness tinnitus
dementia/memory disturbances Inflammatory Bowel Disease torticollis
depressed newborn jaundice transplant recipient
diarrhea/constipation joint pain non-traumatic trauma
difficulty swallowing limb pain in lower extremity in children urinary disorder/incontinence/ incomplete emptying/frequency
dizziness/vertigo lymph adenopathy vomiting/nausea
dysphonia/hoarsness mammogram/routine screening weakness/paralysis
dyspnea/breathlessness mouth/oral disorders weight gain/obesity
ear pain murmur/abnormal heart tones weight loss
edema/ascites/anasarca neck mass/goiter wheezing/coughing
electrolyte disorder numbness/tingling/paresthesia    
falls occult blood in stool    

Name of Surgery(s):

 

Problems with any entries?  Contact Jean Afflerbach

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Revised: September 08, 2011