IAU Logbook Core 6weeks

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INTERNATIONAL AMERICAN UNIVERSITY

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.

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