ER Elective Logbook

Name:
Elective:

If Extramural or IDE, enter identifying course number and name here:

Elective End Week:

Date Patient Seen:

Patient's Age:    Months

Patient's Gender:

Diagnoses:

(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:

Problem List:

 

Notes/Comments:

     

For problems with this form, please contactJean Afflerbach, Web Master
Revised: July 11, 2014