Patient 1:
Patient Info
NR 511 Clinical Log Date of Clinical:
Patient Initials: Gender:
Age Range: Ethnicity:
Visit Info
Minutes: Client Complexity:
Student Level of Function: Comfort Assessment
100% stud
...
Patient 1:
Patient Info
NR 511 Clinical Log Date of Clinical:
Patient Initials: Gender:
Age Range: Ethnicity:
Visit Info
Minutes: Client Complexity:
Student Level of Function: Comfort Assessment
100% student Episodic (Acute condition)
75% student/ 25% preceptor Multiple/chronic/controlled disease
50% student/ 50% preceptor Multiple/chronic/uncontrolled disease
25% student/ 75% preceptor Single/chronic/controlled disease
0% student/ observation only Single/chronic/uncontrolled disease Wellness screening/HPDP Immunizations
Type of Site: Type of Visit:
Follow-up: Acute/Episodic Care Pre-employment physical
Chronic Illness Management Prenatal Visit
DOT Physical School Physical Family Planning Visit STD/STI Visit
Health Maintenance Office Visit Well-child exam Immunizations Well-woman exam IUD Placement/Check
Menopause counseling New OB visit
Other Postpartum visit
Type of Diagnostics: Ordering Diagnostics:
NA
Cardiopulmonary Laboratory
Other Radiology Screening Tools
Procedures: Medications:
Therapeutics:
Education:
Physical Exam:
Coding Diagnosis:
Competencies Skills & Procedures:
Notes:
Patient 2:
Patient Info
Patient Initials: Gender:
Age Range: Ethnicity:
Visit Info
Minutes: Client Complexity:
Student Level of Function: Comfort Assessment
100% student Episodic (Acute condition)
75% student/ 25% preceptor Multiple/chronic/controlled disease
50% student/ 50% preceptor Multiple/chronic/uncontrolled disease
25% student/ 75% preceptor Single/chronic/controlled disease
0% student/ observation only Single/chronic/uncontrolled disease Wellness screening/HPDP Immunizations
Type of Site: Type of Visit:
Follow-up: Acute/Episodic Care Pre-employment physical
Chronic Illness Management Prenatal Visit
DOT Physical School Physical Family Planning Visit STD/STI Visit
Health Maintenance Office Visit Well-child exam Immunizations Well-woman exam IUD Placement/Check
Menopause counseling New OB visit
Other Postpartum visit
Type of Diagnostics: Ordering Diagnostics:
NA
Cardiopulmonary Laboratory
Other Radiology Screening Tools
Procedures: Medications:
Therapeutics:
Education:
Physical Exam:
Coding Diagnosis:
Competencies Skills & Procedures:
Notes:
Patient 3:
Patient Info
Patient Initials: Gender:
Age Range: Ethnicity:
Visit Info
Minutes: Client Complexity:
Student Level of Function: Comfort Assessment
100% student Episodic (Acute condition)
75% student/ 25% preceptor Multiple/chronic/controlled disease
50% student/ 50% preceptor Multiple/chronic/uncontrolled disease
25% student/ 75% preceptor Single/chronic/controlled disease
0% student/ observation only Single/chronic/uncontrolled disease Wellness screening/HPDP Immunizations
Type of Site: Type of Visit:
Follow-up: Acute/Episodic Care Pre-employment physical
Chronic Illness Management Prenatal Visit
DOT Physical School Physical Family Planning Visit STD/STI Visit
Health Maintenance Office Visit Well-child exam Immunizations Well-woman exam
IUD Placement/Check Menopause counseling New OB visit
Other Postpartum visit
Type of Diagnostics: Ordering Diagnostics:
NA
Cardiopulmonary Laboratory
Other Radiology Screening Tools
Procedures: Medications:
Therapeutics:
Education:
Physical Exam:
Coding Diagnosis:
Competencies Skills & Procedures:
Notes:
Patient 4:
Patient Info
Patient Initials: Gender:
Age Range: Ethnicity:
Visit Info
Minutes: Client Complexity:
Student Level of Function: Comfort Assessment
100% student Episodic (Acute condition)
75% student/ 25% preceptor Multiple/chronic/controlled disease
50% student/ 50% preceptor Multiple/chronic/uncontrolled disease
25% student/ 75% preceptor Single/chronic/controlled disease
0% student/ observation only Single/chronic/uncontrolled disease Wellness screening/HPDP Immunizations
Type of Site: Type of Visit:
Follow-up: Acute/Episodic Care Pre-employment physical
Chronic Illness Management Prenatal Visit
DOT Physical School Physical Family Planning Visit STD/STI Visit
Health Maintenance Office Visit Well-child exam Immunizations Well-woman exam IUD Placement/Check
Menopause counseling New OB visit
Other Postpartum visit
Type of Diagnostics: Ordering Diagnostics:
NA
Cardiopulmonary Laboratory
Other Radiology Screening Tools
Procedures: Medications:
Therapeutics:
Education:
Physical Exam:
Coding Diagnosis:
Competencies Skills & Procedures:
Notes:
Patient 5:
Patient Info
Patient Initials: Gender:
Age Range: Ethnicity:
Visit Info
Minutes: Client Complexity:
Student Level of Function: Comfort Assessment
100% student Episodic (Acute condition)
75% student/ 25% preceptor Multiple/chronic/controlled disease
50% student/ 50% preceptor Multiple/chronic/uncontrolled disease
25% student/ 75% preceptor Single/chronic/controlled disease
0% student/ observation only Single/chronic/uncontrolled disease Wellness screening/HPDP Immunizations
Type of Site: Type of Visit:
Follow-up: Acute/Episodic Care Pre-employment physical
Chronic Illness Management Prenatal Visit
DOT Physical School Physical Family Planning Visit STD/STI Visit
Health Maintenance Office Visit Well-child exam Immunizations Well-woman exam IUD Placement/Check
Menopause counseling New OB visit
Other Postpartum visit
Type of Diagnostics: Ordering Diagnostics:
NA
Cardiopulmonary Laboratory
Other Radiology Screening Tools
Procedures: Medications:
Therapeutics:
Education:
Physical Exam:
Coding Diagnosis:
Competencies Skills & Procedures:
Notes:
Patient 6:
Patient Info
Patient Initials: Gender:
Age Range: Ethnicity:
Visit Info
Minutes: Client Complexity:
Student Level of Function: Comfort Assessment
100% student Episodic (Acute condition)
75% student/ 25% preceptor Multiple/chronic/controlled disease
50% student/ 50% preceptor Multiple/chronic/uncontrolled disease
25% student/ 75% preceptor Single/chronic/controlled disease
0% student/ observation only Single/chronic/uncontrolled disease Wellness screening/HPDP Immunizations
Type of Site: Type of Visit:
Follow-up: Acute/Episodic Care Pre-employment physical
Chronic Illness Management Prenatal Visit
DOT Physical School Physical Family Planning Visit STD/STI Visit
Health Maintenance Office Visit Well-child exam Immunizations Well-woman exam IUD Placement/Check
Menopause counseling New OB visit
Other Postpartum visit
Type of Diagnostics: Ordering Diagnostics:
NA
Cardiopulmonary Laboratory
Other Radiology Screening Tools
Procedures: Medications:
Therapeutics:
Education:
Physical Exam:
Coding Diagnosis:
Competencies Skills & Procedures:
Notes:
Patient 7:
Patient Info
Patient Initials: Gender:
Age Range: Ethnicity:
Visit Info
Minutes: Client Complexity:
Student Level of Function: Comfort Assessment
100% student Episodic (Acute condition)
75% student/ 25% preceptor Multiple/chronic/controlled disease
50% student/ 50% preceptor Multiple/chronic/uncontrolled disease
25% student/ 75% preceptor Single/chronic/controlled disease
0% student/ observation only Single/chronic/uncontrolled disease Wellness screening/HPDP Immunizations
Type of Site: Type of Visit:
Follow-up: Acute/Episodic Care Pre-employment physical
Chronic Illness Management Prenatal Visit
DOT Physical School Physical Family Planning Visit STD/STI Visit
Health Maintenance Office Visit Well-child exam Immunizations Well-woman exam IUD Placement/Check
Menopause counseling New OB visit
Other Postpartum visit
Type of Diagnostics: Ordering Diagnostics:
NA
Cardiopulmonary Laboratory
Other Radiology Screening Tools
Procedures: Medications:
Therapeutics:
Education:
Physical Exam:
Coding Diagnosis:
Competencies Skills & Procedures:
Notes:
Patient 8:
Patient Info
Patient Initials: Gender:
Age Range: Ethnicity:
Visit Info
Minutes: Client Complexity:
Student Level of Function: Comfort Assessment
100% student Episodic (Acute condition)
75% student/ 25% preceptor Multiple/chronic/controlled disease
50% student/ 50% preceptor Multiple/chronic/uncontrolled disease
25% student/ 75% preceptor Single/chronic/controlled disease
0% student/ observation only Single/chronic/uncontrolled disease Wellness screening/HPDP Immunizations
Type of Site: Type of Visit:
Follow-up: Acute/Episodic Care Pre-employment physical
Chronic Illness Management Prenatal Visit
DOT Physical School Physical Family Planning Visit STD/STI Visit
Health Maintenance Office Visit Well-child exam Immunizations Well-woman exam
IUD Placement/Check Menopause counseling New OB visit
Other Postpartum visit
Type of Diagnostics: Ordering Diagnostics:
NA
Cardiopulmonary Laboratory
Other Radiology Screening Tools
Procedures: Medications:
Therapeutics:
Education:
Physical Exam:
Coding Diagnosis:
Competencies Skills & Procedures:
Notes:
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