Appendix 3: Case Record (Daily) Form Date of Visit: Department: Patient Name: Age: Gender: Occupation: Chief Complaints: Case History: (Including current illness, pass illness, personal history, family history and etc.) Medical Check-up: (physical check-up, gynaecology examination and etc.) Laboratory Tests: (If any) Analysis of Aetiology and Pathogenesis: Diagnosis of Western Medicine: Diagnosis of TCM: Syndrome Diagnosis: Management/Observation: (Including herbal medicine and acupuncture treatment) Major Herbal Formula: COMMENTS of Preceptor (IF ANY) Intern Name: ____________________________ Signature of Preceptors: _________________________ Intern Signature: _________________________ Date: _________________________________________