IAU Logbook Core 6weeks
IAU Logbook Core 6weeks
IAU Logbook Core 6weeks
College of Medicine
Core Rotation (6 weeks)
CLERKSHIP LOG BOOK
Specialty: Psychiatry Pediatric Family Medicine OB/Gyn
Student Name:
This is to certify that this student, ___________________________________ attended the sessions as entered in this booklet and
fully participate in the educational program. I have discussed with the student my concerns, if any, about this experience here.
His/her conduct in the office was professional and ethical.
Physician Signature: Physician Name:
Physician Title: Name of Institution:
FOR IAU OFFICE USE ONLY
Received by the Department on: Reviewed by: Evaluation:
International American University
Patient Log
In/Out Patient List Student Name:
Rotation: Week: 1 From: To:
Day Date
Patient
Initials Age Sex Chief Complaint Procedures Diagnosis Meeting
Lecture/
Procedure/
Seminars
Attending/
Resident
Signature
P*1
1
P2
P1
2
P2
P1
3
P2
P1
4
P2
P1
5
P2
P* - Patient Page 2 of 7 IAU_Logbook_Core_6weeks.doc
Student meeting, faculty meeting, admin conference, discharge conference, etc. attended
Topics attended, length of time and procedure done.
International American University
Patient Log
In/Out Patient List Student Name:
Rotation: Week: 2 From: To:
Day Date
Patient
Initials Age Sex Chief Complaint Procedures Diagnosis Meeting
Lecture/
Procedure/
Seminars
Attending/
Resident
Signature
P*1
1
P2
P1
2
P2
P1
3
P2
P1
4
P2
P1
5
P2
P* - Patient Page 3 of 7 IAU_Logbook_Core_6weeks.doc
Student meeting, faculty meeting, admin conference, discharge conference, etc. attended
Topics attended, length of time and procedure done.
International American University
Patient Log
In/Out Patient List Student Name:
Rotation: Week: 3 From: To:
Day Date
Patient
Initials Age Sex Chief Complaint Procedures Diagnosis Meeting
Lecture/
Procedure/
Seminars
Attending/
Resident
Signature
P*1
1
P2
P1
2
P2
P1
3
P2
P1
4
P2
P1
5
P2
P* - Patient Page 4 of 7 IAU_Logbook_Core_6weeks.doc
Student meeting, faculty meeting, admin conference, discharge conference, etc. attended
Topics attended, length of time and procedure done.
International American University
Patient Log
In/Out Patient List Student Name:
Rotation: Week: 4 From: To:
Day Date
Patient
Initials Age Sex Chief Complaint Procedures Diagnosis Meeting
Lecture/
Procedure/
Seminars
Attending/
Resident
Signature
P*1
1
P2
P1
2
P2
P1
3
P2
P1
4
P2
P1
5
P2
P* - Patient Page 5 of 7 IAU_Logbook_Core_6weeks.doc
Student meeting, faculty meeting, admin conference, discharge conference, etc. attended
Topics attended, length of time and procedure done.
International American University
Patient Log
In/Out Patient List Student Name:
Rotation: Week: 5 From: To:
Day Date
Patient
Initials Age Sex Chief Complaint Procedures Diagnosis Meeting
Lecture/
Procedure/
Seminars
Attending/
Resident
Signature
P*1
1
P2
P1
2
P2
P1
3
P2
P1
4
P2
P1
5
P2
P* - Patient Page 6 of 7 IAU_Logbook_Core_6weeks.doc
Student meeting, faculty meeting, admin conference, discharge conference, etc. attended
Topics attended, length of time and procedure done.
International American University
Patient Log
In/Out Patient List Student Name:
Rotation: Week: 6 From: To:
Day Date
Patient
Initials Age Sex Chief Complaint Procedures Diagnosis Meeting
Lecture/
Procedure/
Seminars
Attending/
Resident
Signature
P*1
1
P2
P1
2
P2
P1
3
P2
P1
4
P2
P1
5
P2
P* - Patient Page 7 of 7 IAU_Logbook_Core_6weeks.doc
Student meeting, faculty meeting, admin conference, discharge conference, etc. attended
Topics attended, length of time and procedure done.