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Texila American Un

INSTRUCTIONS

Weekly Report Format-PG

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

Texila American University


Weekly Report Format-PG MMSc
INSTRUCTIONS

ective columns. Dont leave the columns blank. Minimum number of cases per week is 10.

CHIEF COMPLAINTS/ SIGNS & SYMPTOMS/ CONDITIONS and DURATION

DIAGNOSIS

TREATMENT SUGGESTED ( 20 WORDS Approx.)

RATING SCALE FOR MENTOR AND PC EXCELLENT GOOD FAIR BAD VERY BAD 10 8 6 4 2

0.

FOLLOW UP DETAILS

REMARKS AND RATINGS REMARKS AND RATINGS BY MENTOR BY PC

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