The Oxford College of Physiotherapy

6/9, 1st Cross, Hongasandra, Bangalore – 560068. Ph: 08061754695.

Clinical Logbook
BPT 3rd Year

The Oxford College of Physiotherapy

6/9, 1st Cross, Hongasandra, Bangalore – 560068. Ph: 08061754695.

Clinical Logbook
BPT 3 Year rd
 STUDENT PROFILE

• Full Name (in block) :

• Batch :

• Registration Number :

• E- Mail ID :

• Mobile No. :

SIGNATURE OF THE STUDENT

Date / Place:

*(If found return this book to the Physiotherapy Department OPD)

STUDENT PROFILE

• Full Name (in block) :

• Batch :

• Registration Number :

• E- Mail ID :

• Mobile No. :

SIGNATURE OF THE STUDENT

Date / Place:

*(If found return this book to the Physiotherapy Department OPD)

DATE: FROM TO

PHYSIO SUPERVISOR NAME:

Date Patient Name Department Condition Assessment Treatment Prognosis Recent Case Signature of staff
Advances Presentation

REMARKS:

OVERALL GRADE: SUPERVISOR SIGNATURE

WITH DATE

DATE: FROM TO

PHYSIO SUPERVISOR NAME:

Date Patient Name Department Condition Assessment Treatment Prognosis Recent Case Signature of staff
Advances Presentation

REMARKS:

OVERALL GRADE: SUPERVISOR SIGNATURE

WITH DATE
DATE: FROM TO

PHYSIO SUPERVISOR NAME:

Date Patient Name Department Condition Assessment Treatment Prognosis Recent Case Signature of staff
Advances Presentation

REMARKS:

OVERALL GRADE: SUPERVISOR SIGNATURE

WITH DATE

DATE: FROM TO

PHYSIO SUPERVISOR NAME:

Date Patient Name Department Condition Assessment Treatment Prognosis Recent Case Signature of staff
Advances Presentation

REMARKS:

OVERALL GRADE: SUPERVISOR SIGNATURE

WITH DATE
 EVALUATION OF CLINICAL PRESENTATION

NAME OF THE FACULTY / MODERATOR: DATE OF PRESENTATION :

S.No. ITEMS FOR OBSERVATION DURING PRESENTATION POOR (0) BELOW AVERAGE GOOD (3) VERY
AVERAGE (2) GOOD (4)
(1)

1 Completeness of history
2 Whether all relevant points elicited
3 Clarity of Presentation
4 Logical Order
5 Mentioned all positive and negative points of importance
6 Accuracy of general physical examination
7 Whether all physical signs elicited correctly
8 Whether any major signs missed or misinterpreted
9 Diagnosis –whether it follows logically from history & findings
10 Investigations required
11 Aims
12 Means
13 Treatment
14 Advice / Other
REMARKS:

OVERALL GRADE: SUPERVISOR SIGNATURE

WITH DATE

EVALUATION OF CLINICAL PRESENTATION

NAME OF THE FACULTY / MODERATOR: DATE OF PRESENTATION :

S.No. ITEMS FOR OBSERVATION DURING PRESENTATION POOR (0) BELOW AVERAGE GOOD (3) VERY
AVERAGE (2) GOOD (4)
(1)

1 Completeness of history
2 Whether all relevant points elicited
3 Clarity of Presentation
4 Logical Order
5 Mentioned all positive and negative points of importance
6 Accuracy of general physical examination
7 Whether all physical signs elicited correctly
8 Whether any major signs missed or misinterpreted
9 Diagnosis –whether it follows logically from history & findings
10 Investigations required
11 Aims
12 Means
13 Treatment
14 Advice / Other
REMARKS:

OVERALL GRADE: SUPERVISOR SIGNATURE

WITH DATE
DATE: FROM TO

PHYSIO SUPERVISOR NAME:

Date Patient Name Department Condition Assessment Treatment Prognosis Recent Case Signature of staff
Advances Presentation

REMARKS:

OVERALL GRADE: SUPERVISOR SIGNATURE

WITH DATE

DATE: FROM TO

PHYSIO SUPERVISOR NAME:

Date Patient Name Department Condition Assessment Treatment Prognosis Recent Case Signature of staff
Advances Presentation

REMARKS:

OVERALL GRADE: SUPERVISOR SIGNATURE

WITH DATE
DATE: FROM TO

PHYSIO SUPERVISOR NAME:

Date Patient Name Department Condition Assessment Treatment Prognosis Recent Case Signature of staff
Advances Presentation

REMARKS:

OVERALL GRADE: SUPERVISOR SIGNATURE

WITH DATE

DATE: FROM TO

PHYSIO SUPERVISOR NAME:

Date Patient Name Department Condition Assessment Treatment Prognosis Recent Case Signature of staff
Advances Presentation

REMARKS:

OVERALL GRADE: SUPERVISOR SIGNATURE

WITH DATE
 EVALUATION OF CLINICAL PRESENTATION

NAME OF THE FACULTY / MODERATOR: DATE OF PRESENTATION :

S.No. ITEMS FOR OBSERVATION DURING PRESENTATION POOR (0) BELOW AVERAGE GOOD (3) VERY
AVERAGE (2) GOOD (4)
(1)

1 Completeness of history
2 Whether all relevant points elicited
3 Clarity of Presentation
4 Logical Order
5 Mentioned all positive and negative points of importance
6 Accuracy of general physical examination
7 Whether all physical signs elicited correctly
8 Whether any major signs missed or misinterpreted
9 Diagnosis –whether it follows logically from history & findings
10 Investigations required
11 Aims
12 Means
13 Treatment
14 Advice / Other
REMARKS:

OVERALL GRADE: SUPERVISOR SIGNATURE

WITH DATE

EVALUATION OF CLINICAL PRESENTATION

NAME OF THE FACULTY / MODERATOR: DATE OF PRESENTATION :

S.No. ITEMS FOR OBSERVATION DURING PRESENTATION POOR (0) BELOW AVERAGE GOOD (3) VERY
AVERAGE (2) GOOD (4)
(1)

1 Completeness of history
2 Whether all relevant points elicited
3 Clarity of Presentation
4 Logical Order
5 Mentioned all positive and negative points of importance
6 Accuracy of general physical examination
7 Whether all physical signs elicited correctly
8 Whether any major signs missed or misinterpreted
9 Diagnosis –whether it follows logically from history & findings
10 Investigations required
11 Aims
12 Means
13 Treatment
14 Advice / Other
REMARKS:

OVERALL GRADE: SUPERVISOR SIGNATURE

WITH DATE
DATE: FROM TO

PHYSIO SUPERVISOR NAME:

Date Patient Name Department Condition Assessment Treatment Prognosis Signature of staff

REMARKS:

OVERALL GRADE: SUPERVISOR SIGNATURE

WITH DATE

DATE: FROM TO

PHYSIO SUPERVISOR NAME:

Date Patient Name Department Condition Assessment Treatment Prognosis Recent Case Signature of staff
Advances Presentation

REMARKS:

OVERALL GRADE: SUPERVISOR SIGNATURE

WITH DATE
DATE: FROM TO

PHYSIO SUPERVISOR NAME:

Date Patient Name Department Condition Assessment Treatment Prognosis Recent Case Signature of staff
Advances Presentation

REMARKS:

OVERALL GRADE: SUPERVISOR SIGNATURE

WITH DATE

DATE: FROM TO

PHYSIO SUPERVISOR NAME:

Date Patient Name Department Condition Assessment Treatment Prognosis Recent Case Signature of staff
Advances Presentation

REMARKS:

OVERALL GRADE: SUPERVISOR SIGNATURE

WITH DATE
 EVALUATION OF CLINICAL PRESENTATION

NAME OF THE FACULTY / MODERATOR: DATE OF PRESENTATION :

S.No. ITEMS FOR OBSERVATION DURING PRESENTATION POOR (0) BELOW AVERAGE GOOD (3) VERY
AVERAGE (2) GOOD (4)
(1)

1 Completeness of history
2 Whether all relevant points elicited
3 Clarity of Presentation
4 Logical Order
5 Mentioned all positive and negative points of importance
6 Accuracy of general physical examination
7 Whether all physical signs elicited correctly
8 Whether any major signs missed or misinterpreted
9 Diagnosis –whether it follows logically from history & findings
10 Investigations required
11 Aims
12 Means
13 Treatment
14 Advice / Other
REMARKS:

OVERALL GRADE: SUPERVISOR SIGNATURE

WITH DATE

EVALUATION OF CLINICAL PRESENTATION

NAME OF THE FACULTY / MODERATOR: DATE OF PRESENTATION :

S.No. ITEMS FOR OBSERVATION DURING PRESENTATION POOR (0) BELOW AVERAGE GOOD (3) VERY
AVERAGE (2) GOOD (4)
(1)

1 Completeness of history
2 Whether all relevant points elicited
3 Clarity of Presentation
4 Logical Order
5 Mentioned all positive and negative points of importance
6 Accuracy of general physical examination
7 Whether all physical signs elicited correctly
8 Whether any major signs missed or misinterpreted
9 Diagnosis –whether it follows logically from history & findings
10 Investigations required
11 Aims
12 Means
13 Treatment
14 Advice / Other
REMARKS:

OVERALL GRADE: SUPERVISOR SIGNATURE

WITH DATE
DATE: FROM TO

PHYSIO SUPERVISOR NAME:

Date Patient Name Department Condition Assessment Treatment Prognosis Recent Case Signature of staff
Advances Presentation

REMARKS:

OVERALL GRADE: SUPERVISOR SIGNATURE

WITH DATE

DATE: FROM TO

PHYSIO SUPERVISOR NAME:

Date Patient Name Department Condition Assessment Treatment Prognosis Recent Case Signature of staff
Advances Presentation

REMARKS:

OVERALL GRADE: SUPERVISOR SIGNATURE

WITH DATE
DATE: FROM TO

PHYSIO SUPERVISOR NAME:

Date Patient Name Department Condition Assessment Treatment Prognosis Recent Case Signature of staff
Advances Presentation

REMARKS:

OVERALL GRADE: SUPERVISOR SIGNATURE

WITH DATE

DATE: FROM TO

PHYSIO SUPERVISOR NAME:

Date Patient Name Department Condition Assessment Treatment Prognosis Recent Case Signature of staff
Advances Presentation

REMARKS:

OVERALL GRADE: SUPERVISOR SIGNATURE

WITH DATE
 EVALUATION OF CLINICAL PRESENTATION

NAME OF THE FACULTY / MODERATOR: DATE OF PRESENTATION :

S.No. ITEMS FOR OBSERVATION DURING PRESENTATION POOR (0) BELOW AVERAGE GOOD (3) VERY
AVERAGE (2) GOOD (4)
(1)

1 Completeness of history
2 Whether all relevant points elicited
3 Clarity of Presentation
4 Logical Order
5 Mentioned all positive and negative points of importance
6 Accuracy of general physical examination
7 Whether all physical signs elicited correctly
8 Whether any major signs missed or misinterpreted
9 Diagnosis –whether it follows logically from history & findings
10 Investigations required
11 Aims
12 Means
13 Treatment
14 Advice / Other
REMARKS:

OVERALL GRADE: SUPERVISOR SIGNATURE

WITH DATE

EVALUATION OF CLINICAL PRESENTATION

NAME OF THE FACULTY / MODERATOR: DATE OF PRESENTATION :

S.No. ITEMS FOR OBSERVATION DURING PRESENTATION POOR (0) BELOW AVERAGE GOOD (3) VERY
AVERAGE (2) GOOD (4)
(1)

1 Completeness of history
2 Whether all relevant points elicited
3 Clarity of Presentation
4 Logical Order
5 Mentioned all positive and negative points of importance
6 Accuracy of general physical examination
7 Whether all physical signs elicited correctly
8 Whether any major signs missed or misinterpreted
9 Diagnosis –whether it follows logically from history & findings
10 Investigations required
11 Aims
12 Means
13 Treatment
14 Advice / Other
REMARKS:

OVERALL GRADE: SUPERVISOR SIGNATURE

WITH DATE
DATE: FROM TO

PHYSIO SUPERVISOR NAME:

Date Patient Name Department Condition Assessment Treatment Prognosis Recent Case Signature of staff
Advances Presentation

REMARKS:

OVERALL GRADE: SUPERVISOR SIGNATURE

WITH DATE

DATE: FROM TO

PHYSIO SUPERVISOR NAME:

Date Patient Name Department Condition Assessment Treatment Prognosis Recent Case Signature of staff
Advances Presentation

REMARKS:

OVERALL GRADE: SUPERVISOR SIGNATURE

WITH DATE
DATE: FROM TO

PHYSIO SUPERVISOR NAME:

Date Patient Name Department Condition Assessment Treatment Prognosis Recent Case Signature of staff
Advances Presentation

REMARKS:

OVERALL GRADE: SUPERVISOR SIGNATURE

WITH DATE

DATE: FROM TO

PHYSIO SUPERVISOR NAME:

Date Patient Name Department Condition Assessment Treatment Prognosis Recent Case Signature of staff
Advances Presentation

REMARKS:

OVERALL GRADE: SUPERVISOR SIGNATURE

WITH DATE
 EVALUATION OF CLINICAL PRESENTATION

NAME OF THE FACULTY / MODERATOR: DATE OF PRESENTATION :

S.No. ITEMS FOR OBSERVATION DURING PRESENTATION POOR (0) BELOW AVERAGE GOOD (3) VERY
AVERAGE (2) GOOD (4)
(1)

1 Completeness of history
2 Whether all relevant points elicited
3 Clarity of Presentation
4 Logical Order
5 Mentioned all positive and negative points of importance
6 Accuracy of general physical examination
7 Whether all physical signs elicited correctly
8 Whether any major signs missed or misinterpreted
9 Diagnosis –whether it follows logically from history & findings
10 Investigations required
11 Aims
12 Means
13 Treatment
14 Advice / Other
REMARKS:

OVERALL GRADE: SUPERVISOR SIGNATURE

WITH DATE

EVALUATION OF CLINICAL PRESENTATION

NAME OF THE FACULTY / MODERATOR: DATE OF PRESENTATION :

S.No. ITEMS FOR OBSERVATION DURING PRESENTATION POOR (0) BELOW AVERAGE GOOD (3) VERY
AVERAGE (2) GOOD (4)
(1)

1 Completeness of history
2 Whether all relevant points elicited
3 Clarity of Presentation
4 Logical Order
5 Mentioned all positive and negative points of importance
6 Accuracy of general physical examination
7 Whether all physical signs elicited correctly
8 Whether any major signs missed or misinterpreted
9 Diagnosis –whether it follows logically from history & findings
10 Investigations required
11 Aims
12 Means
13 Treatment
14 Advice / Other
REMARKS:

OVERALL GRADE: SUPERVISOR SIGNATURE

WITH DATE
 EVALUATION OF CLINICAL PRESENTATION

NAME OF THE FACULTY / MODERATOR: DATE OF PRESENTATION :

S.No. ITEMS FOR OBSERVATION DURING PRESENTATION POOR (0) BELOW AVERAGE GOOD (3) VERY
AVERAGE (2) GOOD (4)
(1)

1 Completeness of history
2 Whether all relevant points elicited
3 Clarity of Presentation
4 Logical Order
5 Mentioned all positive and negative points of importance
6 Accuracy of general physical examination
7 Whether all physical signs elicited correctly
8 Whether any major signs missed or misinterpreted
9 Diagnosis –whether it follows logically from history & findings
10 Investigations required
11 Aims
12 Means
13 Treatment
14 Advice / Other
REMARKS:

OVERALL GRADE: SUPERVISOR SIGNATURE

WITH DATE

EVALUATION OF CLINICAL PRESENTATION

NAME OF THE FACULTY / MODERATOR: DATE OF PRESENTATION :

S.No. ITEMS FOR OBSERVATION DURING PRESENTATION POOR (0) BELOW AVERAGE GOOD (3) VERY
AVERAGE (2) GOOD (4)
(1)

1 Completeness of history
2 Whether all relevant points elicited
3 Clarity of Presentation
4 Logical Order
5 Mentioned all positive and negative points of importance
6 Accuracy of general physical examination
7 Whether all physical signs elicited correctly
8 Whether any major signs missed or misinterpreted
9 Diagnosis –whether it follows logically from history & findings
10 Investigations required
11 Aims
12 Means
13 Treatment
14 Advice / Other
REMARKS:

OVERALL GRADE: SUPERVISOR SIGNATURE

WITH DATE
 EVALUATION OF CLINICAL PRESENTATION

NAME OF THE FACULTY / MODERATOR: DATE OF PRESENTATION :

S.No. ITEMS FOR OBSERVATION DURING PRESENTATION POOR (0) BELOW AVERAGE GOOD (3) VERY
AVERAGE (2) GOOD (4)
(1)

1 Completeness of history
2 Whether all relevant points elicited
3 Clarity of Presentation
4 Logical Order
5 Mentioned all positive and negative points of importance
6 Accuracy of general physical examination
7 Whether all physical signs elicited correctly
8 Whether any major signs missed or misinterpreted
9 Diagnosis –whether it follows logically from history & findings
10 Investigations required
11 Aims
12 Means
13 Treatment
14 Advice / Other
REMARKS:

OVERALL GRADE: SUPERVISOR SIGNATURE

WITH DATE

EVALUATION OF CLINICAL PRESENTATION

NAME OF THE FACULTY / MODERATOR: DATE OF PRESENTATION :

S.No. ITEMS FOR OBSERVATION DURING PRESENTATION POOR (0) BELOW AVERAGE GOOD (3) VERY
AVERAGE (2) GOOD (4)
(1)

1 Completeness of history
2 Whether all relevant points elicited
3 Clarity of Presentation
4 Logical Order
5 Mentioned all positive and negative points of importance
6 Accuracy of general physical examination
7 Whether all physical signs elicited correctly
8 Whether any major signs missed or misinterpreted
9 Diagnosis –whether it follows logically from history & findings
10 Investigations required
11 Aims
12 Means
13 Treatment
14 Advice / Other
REMARKS:

OVERALL GRADE: SUPERVISOR SIGNATURE

WITH DATE
 Leave Particulars
Department
Sr No Reason for Leave No of days Day Staff Signature
Posted in

1)

2)

3)

4)

5)

6)

7)

8)

9)

10)

Leave Particulars
Department
Sr No Reason for Leave No of days Day Staff Signature
Posted in

1)

2)

3)

4)

5)

6)

7)

8)

9)

10)