Observed history and physical feedback form

Family Medicine Clerkship

Student name: __________Vish Bysani____________________

I was directly observed performing a pertinent history on _____6/20/2019___________ (date).

I received feedback on my performance from my preceptor, Dr.

___Frazer______________________.

I was directly observed performing a pertinent physical exam on

____7/8/2019_______________ (date).

I received feedback on my performance from my preceptor,

Dr.______Frazer___________________.