Observed History and Physical Feedback Form Family Medicine Clerkship

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Observed history and physical feedback form

Family Medicine Clerkship

Student name: __________Vish Bysani____________________

I was directly observed performing a pertinent history on _____6/20/2019___________ (date).

I received feedback on my performance from my preceptor, Dr.


___Frazer______________________.

I was directly observed performing a pertinent physical exam on


____7/8/2019_______________ (date).

I received feedback on my performance from my preceptor,


Dr.______Frazer___________________.

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