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- 11/11/2011
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Document Sample
Required Total Patients Objective met Objective met
Patient Encounter Log number of Seen by the
Goal met in
Clinical
Alternative
Learning
with with obth Objective
pateints to Medical Alternative Alterntaive
Met
Pediatrics 1 (JCON 720) Conditions complete the Student
Environment Completed
Learning Only Learning &
objective Patient
1 Newborn 1 0 0 Clinical Only 0
Supervision
I certify this is an accurate account of my patients that met the
Health
2 Child 1 0 0 0 0 0 0
3 Adolescent 1 0 0 0 0 0 0
Date
4 Plot on Growth Chart 3 0 0 Clinical Only 0
5 Neonatal Jaundice 1 0 0 0 0 0 0 0
6 Upper Respiratory Infection 1 0 0 0 0 0 0
Site
7 Lower Respiratory Infection 1 0 0 0 0 0 0
Acute Illness
8 Gastrointestinal Complaint 1 0 0 0 0 0 0
9 Skin Complaint 1 0 0 0 0 0 0
10 CNS Complaint 1 0 0 0 0 0 0
11 Fever without Focus 1 0 0 0 0 0 0
12 Asthma 0
13 Atopic Dermatitus 0
A
14 Cerebral Palsy 0
n
0
Signature
15 Cystic Fibrosis
y
16 Diabetes Mellitus 0
clerkship objectives.
17 Epilepsy 2 0
Chronic Illness
18 Malignancy 0
19 Obesity I 0
0 0 0 0 0
20 Genetic Syndrome l 0
21 Sickle Cell Anemia n 0
22 Immunodeficiency e 0
s
23 Sensory Impairment 0
s
24 Eating Disorder 0
Student Name
e
25 Congenital Heart Defect s 0
Academic Year
0
200910
26 Chronic Renal Failure
Total 0
27 Write medication orders in patient chart 3 0 0 0 0 0 0
28 Write an outpatient prescription 3 0 0 0 0 0 0
29 History & Physical to assess hydration (normal, mild, moderate, severe) 1 0 0 0
Clinical Only
Electrolytes
Fluids &
30 Write orders for child MIVF 1 0 0 0
31 Write fluid resuscitation plan for dehydration 1 0 0 0 0 0 0
Rotation Number
32 Understand and explain utility of ORT for mild-mod dehydration 1 0 0 0 0 0 0
33 Recognize child abuse 1 0 0 0 0 0 0
34 Understand child abuse legal requirements and mandatory reporting 1 0 0 0 0 0 0
1
Patient Encounter Log Alternative Learning Experiances
These are alternatives that are required if students are unable to completely fulfill their course objectives in a clinical setting. Not all course objectives include
Pediatrics 1 (JCON 720) alternative experiences. Students are encouraged to compelete the alternative experience
1 Must be completed in clinic environment.
Supervision
I certify this is an accurate account of my patients that met the
Health
2 CLIPP Cases 3 & 4 Case 3 Incomplete Case 4 Incomplete
3 CLIPP Cases 5 & 6 Case 5 Incomplete Case 6 Incomplete
Date
4 Must be completed in clinic environment.
5 Clipp Case 8 CLIPP Case 8 Incomplete
6 Clipp Case 14 CLIPP Case 14 Incomplete
Site
7 CLIPP Cases 12 & 13 Case 12 Incomplete Case 13 Incomplete
Acute Illness
8 CLIPP Cases 15 & 17 Case 15 Incomplete Case 17 Incomplete
9 CLIPP Cases 3 & 21 Case 3 Incomplete Case 21 Incomplete
10 CLIPP Cases 20, 24 & 28 Case 20 Incomplete Case 24 Incomplete Case 28 Incomplete
11 Clipp Case 10 CLIPP Case 10 Incomplete
12
13
14
Signature
15
16
clerkship objectives.
17
Chronic Illness
18
19
CLIPP CASES 30 & 31 CLIPP Case 30 Incomplete CLIPP Case 31 Incomplete
20
21
22
23
24
Student Name
25
Academic Year
200910
26
27 Medication Order Problem Sets 1, 2 & 3 Problem Set 1 Incomplete Problem Set 2 Incomplete Problem Set 3 Incomplete
28 Prescription Problem Sets 1, 2 & 3 Problem Set 1 Incomplete Problem Set 2 Incomplete Problem Set 3 Incomplete
29 Must be completed in clinic environment.
Electrolytes
Fluids &
30 Must be completed in clinic environment.
31
Pediatrics 1 Fluids Lecture Fluids Lecture Incomplete
Rotation Number
32
33 Pediatrics Core Lecture-Child Abuse Core Lecture Incomplete
34 Clipp Case 25 CLIPP Case 25 Incomplete
2
3
Student Name Site
200910
Signature Date
I certify this is an accurate account of my patients that met the
Rotation Number Academic Year
clerkship objectives.
Fluids & Health
Patient Encounter Log
Chronic Illness Acute Illness
Electrolytes Supervision
Pediatrics 1 (JCON 720)
34
33
32
31
30
29
28
27
26
25
24
23
22
21
20
19
18
17
16
15
14
13
12
11
10
9
8
7
6
5
4
3
2
1
1
2
3
4
5
1
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
4
Student Name Site
200910
Signature Date
I certify this is an accurate account of my patients that met the
Rotation Number Academic Year
clerkship objectives.
Fluids & Health
Patient Encounter Log
Chronic Illness Acute Illness
Electrolytes Supervision
Pediatrics 1 (JCON 720)
34
33
32
31
30
29
28
27
26
25
24
23
22
21
20
19
18
17
16
15
14
13
12
11
10
9
8
7
6
5
4
3
2
1
31
32
33
34
35
36
37
38
39
40
41
42
43
44
45
46
47
48
49
50
51
52
53
54
55
56
57
58
59
60
Objective
Patient Encounter Log Required
number of
Total
Patients Goal met in Alternative
Objective
met with
met with
both Objective
Objectives Met
Pediatrics 2 pateints to Seen by the Clinical Learning Alternative Alterntaive in Pediatrics 1 Met
complete Medical Environment Completed Learning Learning & Pediatrics 2
(JCON 721) the objective Student Only Patient
Patient General Information Contact
1 Newborn 1 0 0 Clinical Only NOT MET 0
Supervision
I certify this is an accurate account of my patients that met the
Health
2 Child 1 0 0 0 0 0 NOT MET 0
3 Adolescent 1 0 0 0 0 0 NOT MET 0
4 Plot on Growth Chart 3 0 0 Clinical Only NOT MET 0
Rotation Site
5 Neonatal Jaundice 1 0 0 0 0 0 NOT MET 0
6 Upper Respiratory Infection 1 0 0 0 0 0 NOT MET 0
Acute Illness 7 Lower Respiratory Infection 1 0 0 0 0 0 NOT MET 0
8 Gastrointestinal Complaint 1 0 0 0 0 0 NOT MET 0
9 Skin Complaint 1 0 0 0 0 0 NOT MET 0
10 CNs Complaint 1 0 0 0 0 0 NOT MET 0
11 Fever without Focus 1 0 0 0 0 0 NOT MET 0
12 Asthma 0
13 Atopic Dermatitis 0
14 Cerebral Palsy A 0
n
0
Signature
15 Cystic Fibrosis
y
16 Diabetes 0
clerkship objectives.
17 Epilepsy 2 0
Chrinic Illness
18 Malignancy 0
19 Obesity I 0
0 0 0 0 NOT MET 0
20 Genetic Syndrome l 0
21 Sickle Cell Anemia n 0
22 Immunodeficiency e 0
s
23 Sensory Empairment 0
s
0
Student Name
24 Eating Disorder
e
25 Congenital Heart Defect 0
Academice Year
s
0
200910
26 Chronic Renal Failure
0
Total 0
27 Write medication orders in patient chart 3 0 0 0 0 0 NOT MET 0
28 Write an outpatient prescription 3 0 0 0 0 0 NOT MET 0
.
29 History & Physical to assess hydration (normal, milde, moderate, severe) 1 0 0 NOT MET 0
Clinical Only
Electrolytes
Fluids &
30 Write orders for child daily MIVF 1 0 0 NOT MET 0
31 Write fluid resus plan for dehydration 1 0 0 0 0 0 NOT MET 0
Rotation Number
721-01
32 Understand and explain utility of ORT for mild-mod dehydration 1 0 0 0 0 0 NOT MET 0
33 Recognize child abuse 1 0 0 0 0 0 NOT MET 0
34 Understand child abuse legal requirements and mandatory reporting 1 0 0 0 0 0 NOT MET 0
35 Understand available resources for injury prevention and treatment
36 Understand available resources for ingestion injury prevention and treatment
37 Identify a specific healthcare issue and complete a project that addresses this need
5
Patient Encounter Log Alternative Learning Experiances
Pediatrics 2
(JCON 721) These are alternatives that are required if students are unable to completely fulfill their course objectives in a clinical setting. Not all course objectives include
alternative experiences. Students are encouraged to compelete the alternative experience
1 Must be completed in clinic environment.
Supervision
I certify this is an accurate account of my patients that met the
Health
2 CLIPP Cases 3 & 4 Case 3 Incomplete Case 4 Incomplete
3 CLIPP Cases 5 & 6 Case 5 Incomplete Case 6 Incomplete
4 Must be completed in clinic environment.
Rotation Site
5 Clipp Case 8 CLIPP Case 8 Incomplete
6 Clipp Case 14 CLIPP Case 14 Incomplete
7 CLIPP Cases 12 & 13 Case 12 Incomplete Case 13 Incomplete
Acute Illness
8 CLIPP Cases 15 & 17 Case 15 Incomplete Case 17 Incomplete
9 CLIPP Cases 3 & 21 Case 3 Incomplete Case 21 Incomplete
10 CLIPP Cases 20, 24 & 28 Case 20 Incomplete Case 24 Incomplete Case 28 Incomplete
11 Clipp Case 10 CLIPP Case 10 Incomplete
12
13
14
Signature
15
16
clerkship objectives.
17
Chrinic Illness
18
19
CLIPP CASES 30 & 31 CLIPP Case 30 Incomplete CLIPP Case 31 Incomplete
20
21
22
23
Student Name
24
25
Academice Year
200910
26
0
27 Medication Order Problem Sets 1, 2 & 3 Problem Set 1 Incomplete Problem Set 2 Incomplete Problem Set 3 Incomplete
28 Prescription Problem Sets 1, 2 & 3 Problem Set 1 Incomplete Problem Set 2 Incomplete Problem Set 3 Incomplete
29 Must be completed in clinic environment.
Electrolytes
Fluids &
30 Must be completed in clinic environment.
31
Rotation Number
721-01
Pediatrics 1 Fluids Lecture Fluids Lecture Incomplete
32
33 Pediatrics Core Lecture-Child Abuse Core Lecture Incomplete
34 Clipp Case 25 CLIPP Case 25 Incomplete
35
36
37
6
0
7
Student Name Rotation Site
721-01 200910
Signature
I certify this is an accurate account of my patients that met the
Pediatrics 2
(JCON 721)
Rotation Number Academice Year
clerkship objectives.
Fluids & Health
Patient Encounter Log
Chrinic Illness Acute Illness
Electrolytes Supervision
35
37
36
34
33
32
31
30
29
28
27
26
25
24
23
22
21
20
19
18
17
16
15
14
13
12
11
10
9
8
7
6
5
4
3
2
1
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
0
8
Student Name Rotation Site
721-01 200910
Signature
I certify this is an accurate account of my patients that met the
Pediatrics 2
(JCON 721)
Rotation Number Academice Year
clerkship objectives.
Fluids & Health
Patient Encounter Log
Chrinic Illness Acute Illness
Electrolytes Supervision
35
37
36
34
33
32
31
30
29
28
27
26
25
24
23
22
21
20
19
18
17
16
15
14
13
12
11
10
9
8
7
6
5
4
3
2
1
31
32
33
34
35
36
37
38
39
40
41
42
43
44
45
46
47
48
49
50
51
52
53
54
55
56
57
58
59
60
Objective
Patient Encounter Log 0 0
Required
number of
Total
Patients Goal met in Alternative
Objective
met with
met with
both
Total
Patients Goal met in
Objective
Pediatrics 1 & 2 pateints to Seen by the Clinical Learning Alternative Alterntaive
Met
Seen by the Clinical
complete Medical Environment Completed Learning Learning & Medical Environment
(JCON 720 & 721) Name
the objective Student Only Patient Student
Student Number Contact
Objective Pediatrics 1 & 2 Combined P
I certify this is an accurate account of my patients 1 Newborn 1 0 0 Clinical Only 0 0 0
Supervision
Health
2 Child 1 0 0 0 0 0 0 0 0
Date
3 Adolescent 1 0 0 0 0 0 0 0 0
4 Plot on Growth Chart 3 0 0 Clinical Only 0 0 0
5 Neonatal Jaundice 1 0 0 0 0 0 0 0 0
6 1 0 0 0 0 0 0 0 0
that met the clerkship objectives.
Upper Respiratory Infection
7 Lower Respiratory Infection 1 0 0 0 0 0 0 0 0
Acute Illness
8 Gastrointestinal Complaint 1 0 0 0 0 0 0 0 0
9 Skin Complaint 1 0 0 0 0 0 0 0 0
10 CNs Complaint 1 0 0 0 0 0 0 0 0
Signature
11 Fever without Focus 1 0 0 0 0 0 0 0 0
12 Asthma 0 0
13 Atopic Dermatitis 0 0
A
14 Cerebral Palsy 0 0
n
15 Cystic Fibrosis
y
0 0
16 Diabetes 0 0
17 Epilepsy 2 0 0
Chrinic Illness
18 Malignancy 0 0
19 Obesity I 0 0
Rotation
0 1 1 0 1 0
721-01
20 Genetic Syndrome l 0 0
0
21 Sickle Cell Anemia n 0 0
22 Immunodeficiency e 0 0
s
23 Sensory Empairment 0 0
s
24 Eating Disorder 0 0
e
25 Congenital Heart Defect s 0 0
26 Chronic Renal Failure 0 0
Site
Total 0 0
0
0
27 Write medication orders in patient chart 3 0 0 0 0 0 0 0 0
28 Write an outpatient prescription 3 0 0 0 0 0 0 0 0
29 History & Physical to assess hydration (normal, milde, moderate, severe) 1 0 0 0 0 0
Clinical Only
Electrolytes
Fluids &
30 Write orders for child daily MIVF 1 0 0 0 0 0
200910
200910
Years
31 Write fluid resus plan for dehydration 1 0 0 0 0 0 0 0 0
32 Understand and explain utility of ORT for mild-mod dehydration 1 0 0 0 0 0 0 0 0
33 Recognize child abuse 1 0 0 0 0 0 0 0 0
Pediatrics 1
Pediatrics 2
34 Understand child abuse legal requirements and mandatory reporting 1 0 0 0 0 0 0 0 0
Class
35 Understand available resources for injury prevention and treatment 0
36 Understand available resources for ingestion injury prevention and treatment 0
37 Identify a specific healthcare issue and complete a project that addresses this need 0
9
10
Pediatrics 1 200910 0 0
Signature Date
Pediatrics 2 200910 0 721-01
I certify this is an accurate account of my patients
Class Years Site Rotation that met the clerkship objectives.
Fluids & Health
Acute Illness
Pediatrics 1 & 2
Electrolytes Chrinic Illness Supervision
(JCON 720 & 721)
9
8
7
6
5
4
3
2
1
Patient Encounter Log
37
36
35
34
33
32
31
30
29
28
27
26
25
24
23
22
21
20
19
18
17
16
15
14
13
12
11
10
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
Learning
Alternative
Completed
Pediatrics 1
Clinical Only
Clinical Only
Clinical Only
Incomplete Doernbecher 720-01 721-01 1
Attended St Vincent 720-02 721-02 2
Incomplete Legacy Emanuel 720-03 721-03 3
Completed 720-04 721-04 4
720-05 721-05 5
720-06 721-06
720-07 721-07
720-08 721-08
721-09
721-10
721-11
721-12
