CLINICAL PRACTICAL TRAINING
SUMMARY OF PATIENTS ASSIGNED TO THE SUDENT
NO. (
)
 It is acceptable in some other forms if all required contents are included as a summary.
 If the student was not assigned to have particular patients due to a clinical practical training in
departments of anesthesia or radiology, he/she may generate a summary of anesthesia or a report
on a diagnostic imaging with a patient history and main data.
Name of student:
Matriculation number :
Name of attending doctor:
Name of supervisory doctor:
Name of hospital / Name of diagnosis and treatment department:
Case (initial):
Age:
Sex:
Occupation:
Chief complaint:
Present illness:
sleeping:
Stool:
urine:
appetite:
menstration:
Past history:
Social and life histories:
alcohol drinking:
smoking:
other favorite articles:
Family history:
Physical findings:
Stature and nutrition / vital signs
hight:
cm
consciousness:
weight:
pulse:
Face and Neck
Chest
Abdomen
Extremities/ Rectum/ Anus/ Genitals
Nervous system
Laboratory data:
Urinalysis
CBC
Blood chemistry
Serological test
Imaging findings, etc.
electrocardiogram
chest X-ray
kg
BMI:
blood pressure:
chest circumference:
condition of the nutrition:
cm
Problems list:
#1.
#2.
#3.
#4.
#5.
Assessment and Plan:
Signature:
Responsible official