Name: Location:
Patient Procedure Log - Rural Health Clerkship (JCON 722)
Note: Please enter all patients that meet one or more objectives - numbers in parentheses are for use by clerkship coordinator
YOUR CLERKSHIP GRADE IS NOT RELATED TO THE NUMBER OF CLERKSHIP OBJECTIVES YOU MEET
Patient: Total 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24
Basic Oral Health Evaluation (exams should be performed on
pediatrics, adult, and/or geriatric patients representative of the practice type (5) 0
Geriatric screening and assessments (Using one or more of the
following Geriatric Depression Scale, MMSE, dementia screening tests, mobility/fall
risk assessments, Functional assessments, sensory assessments, substance abuse
screening) (5) Note: this requirement may not be applicable at pediatric only sites. 0
Continuity Visits (follow up when student has seen patient before in
outpatient or inpatient setting) (5) 0
Pediatric or adolescent patients (well child or acute visit) (5) 0
Chronic disease management (participate in outpatient coordination
of care, med management, or evaluation of diabetes, hypertension, congestive heart
failure or other chronic disease) (5) 0
Substance use/abuse/addiction evaluation or management (counseling or treatment
for substance related issues such as tobacco, alcohol, drugs, gambling) (5) 0
Domestic violence assessment/counseling (2) 0
Musculoskeletal management-chronic or acute issues (osteoarthritis,
rheumatism, back pain, sprain, strain, fracture, tendonitis) (5) 0
0
Participate in minor procedures (i.e., cerumen impaction, punch biopsy, joint or bursa injection, casting/splinting, cryotherapy) (5)
Observe or participate in surgical procedure (2) 0
Utilize on-line resources to access patient care information and data appropriate to
community project or patient care. Utilize on-line resources to access patient
education materials (5) 0
Utilize on-line resources to access patient care
information, education materials or data (3) 0
Identify and assist with implementation of patient related community resources and
support services needed for patient care (i.e., home health, hospice, meals on wheels,
mental health services, social services) (2) 0
Psychosocial assessment or counseling: marital issues, motivational interviewing,
weight management, stress) (3) 0
Referral for consultation/coordination of care (participate in the decision making
process regarding specialty referral) (3) 0
Participate in community event (1) 0
Obstetric deliveries (Note: this many not be available in all practice setting) (2) 0
Preventive care visits (well child/adolescent, adult physical exam, well woman exam,
preventive counseling visits) (5) 0
Emergency or urgent evaluation of adult patient (in emergency dept. or office based
urgent care setting) (3) 0
Interpretation of radiographic images (3) 0
Sign Here:
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