USC Procedure Log
STUDENT: ____________________________________________________
Rotation Site / Preceptor:_________________________________________
Rotation Date: ________________
Rotation Period #:_______________
Clinical faculty review (mid-rotation):__________________________________________
(Clinical faculty signature / Date)
Clinical faculty review (end of rotation):________________________________________
(Clinical faculty signature / Date)
Students are required to complete the Student Log to receive credit for the rotation. The log’s purpose is to ensure that each student is exposed to the
depth and breadth of USC in the Family Medicine Setting. The log is divided into two areas: clinical presentations and procedures that the student
should perform. Please document the number of procedures in which you performed.
For each clinical presentation/procedure listed below, record:
a) The number seen. *Remember, a patient may have more than one diagnosis or procedure.
b) If not seen, please mark appropriate column.
Clinical Presentation
Example: Headache (HA)
Pneumonia (Adult)
Basal Cell Carcinoma
Squamous Cell Carcinoma
Melanoma
Halo Nevi
MRSA
Tinea Skin Infections
Sinusitis
COPD
Chest Pain
Cardiac Risk Factors
TIA
CVA
Bell’s Palsy
Knee Pain
Carpal Tunnel Syndrome
Gastritis
Abnormal Vaginal Bleeding
Delirium
Dementia
Fractures
Pediatric Dehydration
Laceration
Meningitis
Stress Fractures
Dermatitis
The Red Eye
Insomnia
Count
Numeric
10
Not
Seen
Comments
For each procedure listed below, record either:
a) The number of procedures performed. (The target minimum is for your reference, but please record the total number of procedures performed.)
b) If procedure was not performed, please mark appropriate column.
Procedure
Example: Laceration repair
Urinalysis dip
Pap
Pelvic Exam (Speculum and bimanual)
Breast Exam
Rectal Exam
Hemocult
Chest x-ray interpretation
Laceration repair
Punch Biopsy or excision of skin lesion
Suture Removal
Wound Care
Venipuncture
Pulse Ox
I + D Absesses
Splint Application
Immunization Administration
Cryosurgery of skin lesion
Local anesthesia for procedure
Cerumen removal by irrigation
Office EKG
PFT’s or Peak flow (office)
Eye Fluorescene Staining
Smoking cessation counseling
CLIA Waived Tests
HgbA1c
TSH
Strep
Mono
HCG
Hb
INR
Accucheck
Target
minimum
#(Numeric)
Performed
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
Observed/Asst
Faculty
Comments