Y4 Internal Medicine Patient Encounter Elective Logbook

Student Name:

Class:
Elective

If Extramural or IDE, enter identifying information here:
Elective End Week:

Date Patient Seen:
Patient's Age:  

Patient's Gender:
Location:
Chief Complaint:
(to select more than one item, click on each item while holding down the <control> key)
Primary Patient Problem:
Patient Problem 2:
Patient Problem 3:
Patient Category
Procedure:
(to select more than one item, click on each item while holding down the <control> key)
Procedure Role:

Problem List:

Notes/Comments:

Medical Errors:

Problems with any entries?  Contact Jean Afflerbach

Revised: September 06, 2012