CLINICAL LOG
Name:
Clinical Site
Pt / Population
Site/unit:
Date(s) of
assignment:
Age: Race:
Gender: M F
or Population
description:
Site/unit:
Date(s) of
assignment:
Age: Race:
Gender: M F
or Population
description:
Site/unit:
Date(s) of
assignment:
Age: Race:
Gender: M F
or Population
description:
Diagnosis and/or major problems:
(patient, community, group, etc.)
Diagnostic/treatment/or surgical Learning activities/skills/observations
procedures
(What did you see, do, and/or learn)
Clinical Site
Pt / Population
Site/unit:
Date(s) of
assignment:
Age: Race:
Gender: M F
or Population
description:
Site/unit:
Date(s) of
assignment:
Age: Race:
Gender: M F
or Population
description:
Site/unit:
Date(s) of
assignment:
Age: Race:
Gender: M F
or Population
description:
Diagnosis and/or major problems:
(patient, community, group, etc.)
Diagnostic/treatment/or surgical Learning activities/skills/observations
procedures
(What did you see, do, and/or learn)