NR 511 Clinical Log Template.

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 A ssessment 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: Show Less