Y4 FAMILY & COMMUNITY MEDICINE LOGBOOK

Student Name:
Elective

If Extramural or IDE, enter identifying information here:
Class:
Elective End Week:
Date Patient Seen:   
Age:
Patient's Race: Patient's Gender:
Type of Problem: Location: 
Chief Complaint:
(to select more than one item, click on each item while holding down the <control> key)
Primary Diagnosis:
Diagnosis 2:
Diagnosis 3:

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

Problem List:

Notes/Comments:

 

 

 

 

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 Jean Afflerbach (Web Master)

Page last updated Thursday January 07, 2010

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