Name:

*Select Student Name Ade, Timothy Altheimer, Alicia Austin, Richard Balagna, Jonathan Barfield, Andrew Barrientos, Earl Bauman, John Becker, Amanda Belden, Chelsea Betzle, Christopher Bhattacharya, Shalini Billington, Joshua Boehmer, Brian Boucek, Lisa Bowers, Derek Bradley, Melissa Canaday, Dian Castelli, Rachel Cavataio, Antonino Chandra, Sidharth Cheatham, Terah Claussen, Alex Combs, Ryan Craig, Hannah Dawood, Moiz Day, Rachel Dodia, Neal Eckhardt, Michael Feller, Cathy Frank, Amelia Galanos, Kelly Glaenzer, Bryan Grasch, Anton Grimm, Trenton Guignon, Michael Hagene, Michelle Hamm, Brandon Haryani, Anand Hassenflug, Jeffrey Henke, Adam Henkle, Benjamin Hiatt, Elizabeth Holland, Marshall Holland, Raven Holland, Stephen Horberg, John Horwitz, Mara Hovland, Rebekah Hubbard, Jeffrey Jefferson, Stacy Jimenez, Monica Johnson, Graham Johnson, Kevin Jones, Braden Juvinall, Douglas Keeler, Aisha Ken, Jonathan Ken, Kimberly Khan, Imran Koch, Craig Kopec, Gretchen Kottwitz, Michael Kulacz, Jeremy Kyte, Natasha Leverenz, Ashley Malvik, Natalie Martinek, Christopher Mathews, Dionna Mathis, Benjamin Mayfield, Allison McConomy, Bryan McCoy, Kara McKenna, Katherine McNeese, Safiya Meyer, Bria Michael, Alex Michaels, Jason Mickus, Gregory Miedema, Christopher Mikesell, Timothy Miksanek, Zachary Miller, Peter Moore, DeAnn Moss, Jacob Nester, William Obert, Brittany Oke, Tolulope Owusu, Rosemary Oxford, KariJane Parenteau, Michael Parke, Jacob Patel, Dhara Patel, Raunak Patel, Sonal Patil, Shruti Pitts, Aisha Pitzen, Joshua Potsch, Shirley Powell, Keisha Raab, Joseph Rabideau, Amanda Rebeiro, Sumi Reed, Jennifer Reed, Loren Reid, Taylor Rivera, Alexis Roloff, Carolyn Ros, Sara Rosenkrans, Daniel Rubino, Jessica Ruebhausen, Michael Ryan, Daniel Sadowski, Daniel Sanserino, Kathryne Schmucker, Drew Schuh, Robert Selby, Thomas Serafin, Mateusz Simon, Kevin Snyder, Emily Socks, Britanne Spencer, Lauren Stouffer, Jordan Suppiah, Somu Swong, Michael Taylor, Cameron Tennill, Robert Thompson, Kirk Thompson, Lauren Tignor, Emily Truscott, Jamie Urish, Ashley Varney, Brittany Varney, Jacob Velazquez, Amanda Volkman, Emma Wakid, Christopher Walters, Megan Washington, Vance Weitzel, Laura Wells, Sarah Wetter Taylor, Nate Williams, Cody Williams, Gisela Wright, Alex Yanik, Susan Yoon, Kristopher Yu, Xin Zubairu, Josiah zzTest

Elective End Week:

*Choose End Week 01 - Jul-09, 2012 02 - Jul-16, 2012 03 - Jul-23, 2012 04 - Jul-30, 2012 05 - Aug-06 2012 06 - Aug-13, 2012 07 - Aug-20, 2012 08 - Aug-27, 2012 09 - Sep-03, 2012 10 - Sep-10, 2012 11 - Sep-17, 2012 12 - Sep-24, 2012 13 - Oct-01 2012 14 - Oct-08, 2012 15 - Oct-15, 2012 16 - Oct-22, 2012 17 - Oct-29, 2012 18 - Nov-05, 2012 19 - Nov-12, 2012 20 - Nov-19, 2012 21 - Nov-26, 2012 22 - Dec-03, 2012 23 - Dec-10, 2012 24 - Dec-17, 2012 25 - Dec-24, 2012 26 - Dec-31, 2012 27 - Jan-07, 2013 28 - Jan-14, 2013 29 - Jan-21, 2013 30 - Jan-28, 2013 31 - Feb-04, 2013 32 - Feb-11, 2013 33 - Feb-18, 2013 34 - Feb-25, 2013 35 - Mar-04, 2013 36 - Mar-11, 2013 37 - Mar-18, 2013 38 - Mar-25, 2013 39 - Apr-01 2013 40 - Apr-08, 2013 41 - Apr-15, 2013 42 - Apr-22, 2013 43 - Apr-29, 2013 44 - May-06, 2013 45 - May-13, 2013 46 - May-20, 2013 47 - May-27, 2013 48 - June 3, 2013 49 - June 10, 2013 50 - June 17, 2013

Class: 2013 2014

Elective

* Select Elective **Extramural Elective **Individually Designed Elective 10013 - Clinical Anesthesia

If Extramural or IDE, enter identifying information here:

Date Patient Seen:

Patient's Age:

   Years      Months

Patient's Gender:

Male Female    

Location: 

Clinic ER Home Visit In-Patient Nursing Home Other Out-Patient Surgery

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

*None Abdominal mass Abdominal pain Abnormal ECG Abnormal Liver Function Tests Abnormalities of White Blood Cells Acid Base and Electrolyte Problems Acute and Chronic Renal Failure Acute Coronary Syndromes Alcoholism/substance abuse Allergic Reactions Altered mental status Anaphylaxis/allergic reactions Anemia Anxiety/Nervousness Arthritis Asthma/Chronic Obstructive Lung Disease Back/neck pain Bleeding Tendency/Bruising Breast Disorders Breast mass or lump Cancer Cardiac Arrest/Respiratory Arrest Chest pain Chronic Kidney Disease Chronic pain Common Cancers Congestive Heart Failure Constipation COPD and Asthma Coronary Artery Disease Cough Cyanosis/Hypoxia Dementia/Memory Disturbances Depression Diabetes Mellitus Diarrhea/Constipation Difficulty Swallowing Dizziness/Vertigo Domestic Violence Dyslipidemia Ear pain Eating Disorders Edema/Anasarca/Ascites Electrolyte and Acid Base Disorders End - of -life issues Extremity pain Eye pain Fall Fatigue/weakness Fever/Sepsis Follow-up: abnormal lab test Follow-up: abnormal stress test Follow-up: medication change Gastrointestinal Bleeding Genetics in Clinical Practice Geriatric Care Headache Health maintenance assessment Hearing Loss/Deafness Heartburn/indigestion Hematuria Hemoptysis Hepatobiliary Disease HIV infection Hyperlipidemia Hypertension Impaired Consciousness Impotence Infertility Issues of bad news/dying patients Jaundice Joint Pain Leg swelling Liver Disease (acute or chronic) Low Back Pain Lymphadenopathy Menopause Menstrual irregularities Nausea/ vomiting Neck Mass/Goiter Neck pain Numbness/Tingling/Paresthesias Obesity Palpitations Panic/Anxiety Pap smear abnormality Paralysis Pelvic pain or mass Peptic Ulcer Disease/GERD Pneumonia Poisoning Polycythemia/Elevated Hemoglobin Pregnancy Preoperative evaluation Preventive Health Proteinuria Pruritus Psychosis Pupil Abnormalities Rash Rectal pain/bleeding Respiratory Infections/Pneumonia Seizures Seizures (epilepsy) Sexual Dysfunction Sexually transmitted diseases Shock/Hypotension Shortness of breath Skin lesions or abnormality Sleep disturbances Splenomegaly Substance Abuse/Drug Addiction/Withdrawal Throat symptoms - pain/ difficulty swallowing Thromboembolic Disease Thyroid Disease Tinnitus Trauma -major and minor Tuberculosis Upper respiratory infection Urethral discharge Urinary difficulty Urinary Tract Infection Vaginal bleeding Vaginal discharge/itching Venous Thromboembolism Visual Disturbance/Loss Vomiting/Nausea Weakness/Paralysis Weight Gain/Obesity Weight loss Women's Health

Primary Diagnosis:

*None Abdominal mass Abdominal pain Abnormal ECG Abnormal Liver Function Tests Abnormalities of White Blood Cells Acid Base and Electrolyte Problems Acute and Chronic Renal Failure Acute Coronary Syndromes Alcoholism/substance abuse Allergic Reactions Altered mental status Anaphylaxis/allergic reactions Anemia Anxiety/Nervousness Arthritis Asthma/Chronic Obstructive Lung Disease Back/neck pain Bleeding Tendency/Bruising Breast Disorders Breast mass or lump Cancer Cardiac Arrest/Respiratory Arrest Chest pain Chronic Kidney Disease Chronic pain Common Cancers Congestive Heart Failure Constipation COPD and Asthma Coronary Artery Disease Cough Cyanosis/Hypoxia Dementia/Memory Disturbances Depression Diabetes Mellitus Diarrhea/Constipation Difficulty Swallowing Dizziness/Vertigo Domestic Violence Dyslipidemia Ear pain Eating Disorders Edema/Anasarca/Ascites Electrolyte and Acid Base Disorders End - of -life issues Extremity pain Eye pain Fall Fatigue/weakness Fever/Sepsis Follow-up: abnormal lab test Follow-up: abnormal stress test Follow-up: medication change Gastrointestinal Bleeding Genetics in Clinical Practice Geriatric Care Headache Health maintenance assessment Hearing Loss/Deafness Heartburn/indigestion Hematuria Hemoptysis Hepatobiliary Disease HIV infection Hyperlipidemia Hypertension Impaired Consciousness Impotence Infertility Issues of bad news/dying patients Jaundice Joint Pain Leg swelling Liver Disease (acute or chronic) Low Back Pain Lymphadenopathy Menopause Menstrual irregularities Nausea/ vomiting Neck Mass/Goiter Neck pain Numbness/Tingling/Paresthesias Obesity Palpitations Panic/Anxiety Pap smear abnormality Paralysis Pelvic pain or mass Peptic Ulcer Disease/GERD Pneumonia Poisoning Polycythemia/Elevated Hemoglobin Pregnancy Preoperative evaluation Preventive Health Proteinuria Pruritus Psychosis Pupil Abnormalities Rash Rectal pain/bleeding Respiratory Infections/Pneumonia Seizures Seizures (epilepsy) Sexual Dysfunction Sexually transmitted diseases Shock/Hypotension Shortness of breath Skin lesions or abnormality Sleep disturbances Splenomegaly Substance Abuse/Drug Addiction/Withdrawal Throat symptoms - pain/ difficulty swallowing Thromboembolic Disease Thyroid Disease Tinnitus Trauma -major and minor Tuberculosis Upper respiratory infection Urethral discharge Urinary difficulty Urinary Tract Infection Vaginal bleeding Vaginal discharge/itching Venous Thromboembolism Visual Disturbance/Loss Vomiting/Nausea Weakness/Paralysis Weight Gain/Obesity Weight loss Women's Health

Diagnosis 2:

*None Abdominal mass Abdominal pain Abnormal ECG Abnormal Liver Function Tests Abnormalities of White Blood Cells Acid Base and Electrolyte Problems Acute and Chronic Renal Failure Acute Coronary Syndromes Alcoholism/substance abuse Allergic Reactions Altered mental status Anaphylaxis/allergic reactions Anemia Anxiety/Nervousness Arthritis Asthma/Chronic Obstructive Lung Disease Back/neck pain Bleeding Tendency/Bruising Breast Disorders Breast mass or lump Cancer Cardiac Arrest/Respiratory Arrest Chest pain Chronic Kidney Disease Chronic pain Common Cancers Congestive Heart Failure Constipation COPD and Asthma Coronary Artery Disease Cough Cyanosis/Hypoxia Dementia/Memory Disturbances Depression Diabetes Mellitus Diarrhea/Constipation Difficulty Swallowing Dizziness/Vertigo Domestic Violence Dyslipidemia Ear pain Eating Disorders Edema/Anasarca/Ascites Electrolyte and Acid Base Disorders End - of -life issues Extremity pain Eye pain Fall Fatigue/weakness Fever/Sepsis Follow-up: abnormal lab test Follow-up: abnormal stress test Follow-up: medication change Gastrointestinal Bleeding Genetics in Clinical Practice Geriatric Care Headache Health maintenance assessment Hearing Loss/Deafness Heartburn/indigestion Hematuria Hemoptysis Hepatobiliary Disease HIV infection Hyperlipidemia Hypertension Impaired Consciousness Impotence Infertility Issues of bad news/dying patients Jaundice Joint Pain Leg swelling Liver Disease (acute or chronic) Low Back Pain Lymphadenopathy Menopause Menstrual irregularities Nausea/ vomiting Neck Mass/Goiter Neck pain Numbness/Tingling/Paresthesias Obesity Palpitations Panic/Anxiety Pap smear abnormality Paralysis Pelvic pain or mass Peptic Ulcer Disease/GERD Pneumonia Poisoning Polycythemia/Elevated Hemoglobin Pregnancy Preoperative evaluation Preventive Health Proteinuria Pruritus Psychosis Pupil Abnormalities Rash Rectal pain/bleeding Respiratory Infections/Pneumonia Seizures Seizures (epilepsy) Sexual Dysfunction Sexually transmitted diseases Shock/Hypotension Shortness of breath Skin lesions or abnormality Sleep disturbances Splenomegaly Substance Abuse/Drug Addiction/Withdrawal Throat symptoms - pain/ difficulty swallowing Thromboembolic Disease Thyroid Disease Tinnitus Trauma -major and minor Tuberculosis Upper respiratory infection Urethral discharge Urinary difficulty Urinary Tract Infection Vaginal bleeding Vaginal discharge/itching Venous Thromboembolism Visual Disturbance/Loss Vomiting/Nausea Weakness/Paralysis Weight Gain/Obesity Weight loss Women's Health

Diagnosis 3:

*None Abdominal mass Abdominal pain Abnormal ECG Abnormal Liver Function Tests Abnormalities of White Blood Cells Acid Base and Electrolyte Problems Acute and Chronic Renal Failure Acute Coronary Syndromes Alcoholism/substance abuse Allergic Reactions Altered mental status Anaphylaxis/allergic reactions Anemia Anxiety/Nervousness Arthritis Asthma/Chronic Obstructive Lung Disease Back/neck pain Bleeding Tendency/Bruising Breast Disorders Breast mass or lump Cancer Cardiac Arrest/Respiratory Arrest Chest pain Chronic Kidney Disease Chronic pain Common Cancers Congestive Heart Failure Constipation COPD and Asthma Coronary Artery Disease Cough Cyanosis/Hypoxia Dementia/Memory Disturbances Depression Diabetes Mellitus Diarrhea/Constipation Difficulty Swallowing Dizziness/Vertigo Domestic Violence Dyslipidemia Ear pain Eating Disorders Edema/Anasarca/Ascites Electrolyte and Acid Base Disorders End - of -life issues Extremity pain Eye pain Fall Fatigue/weakness Fever/Sepsis Follow-up: abnormal lab test Follow-up: abnormal stress test Follow-up: medication change Gastrointestinal Bleeding Genetics in Clinical Practice Geriatric Care Headache Health maintenance assessment Hearing Loss/Deafness Heartburn/indigestion Hematuria Hemoptysis Hepatobiliary Disease HIV infection Hyperlipidemia Hypertension Impaired Consciousness Impotence Infertility Issues of bad news/dying patients Jaundice Joint Pain Leg swelling Liver Disease (acute or chronic) Low Back Pain Lymphadenopathy Menopause Menstrual irregularities Nausea/ vomiting Neck Mass/Goiter Neck pain Numbness/Tingling/Paresthesias Obesity Palpitations Panic/Anxiety Pap smear abnormality Paralysis Pelvic pain or mass Peptic Ulcer Disease/GERD Pneumonia Poisoning Polycythemia/Elevated Hemoglobin Pregnancy Preoperative evaluation Preventive Health Proteinuria Pruritus Psychosis Pupil Abnormalities Rash Rectal pain/bleeding Respiratory Infections/Pneumonia Seizures Seizures (epilepsy) Sexual Dysfunction Sexually transmitted diseases Shock/Hypotension Shortness of breath Skin lesions or abnormality Sleep disturbances Splenomegaly Substance Abuse/Drug Addiction/Withdrawal Throat symptoms - pain/ difficulty swallowing Thromboembolic Disease Thyroid Disease Tinnitus Trauma -major and minor Tuberculosis Upper respiratory infection Urethral discharge Urinary difficulty Urinary Tract Infection Vaginal bleeding Vaginal discharge/itching Venous Thromboembolism Visual Disturbance/Loss Vomiting/Nausea Weakness/Paralysis Weight Gain/Obesity Weight loss Women's Health

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

*None Arterial Puncture Bladder Catheterization Bone Marrow Central venous catheterization CPR Endotracheal (ET) intubation History and Physical ID Injection IM Injection IV Start LMA insertion Lumbar Puncture Mask ventilation. NG Intubation Paracentesis Proctoscopy Regional anesthesia Stool Guaiac Thoracentesis Tonometry Exam Urinalysis Venipuncture

Procedure Role:

None Observed Assisted Performed

Problem List:

Notes/Comments: