Professional Documents
Culture Documents
INSTRUCTIONS
Type the details in the respective columns. Dont leave the columns b
Name: Program/Specialization: Date of Report: TO
SL.NO
DATE
OP NO OF PATIENT
SEX
AGE
HOSPITAL/CLINIC
ective columns. Dont leave the columns blank. Minimum number of cases per week is 10.
DIAGNOSIS
RATING SCALE FOR MENTOR AND PC EXCELLENT GOOD FAIR BAD VERY BAD 10 8 6 4 2
0.
FOLLOW UP DETAILS