Y4 Internal Medicine Patient Encounter Elective Logbook

Student Name:
Elective

If Extramural or IDE, enter identifying information here:
Class:
Elective End Week:
Date Patient Seen:   
Patient's Age:  
Patient's Race:
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:

 

Jean Afflerbach, Web Master
Copyright © 2008 Board of Trustees, Southern Illinois University. All rights reserved.
Revised: 11/06/2009