CLINICAL LOG BOOK

DOCTOR OF PHYSICAL
THERAPY
DPT 5TH SEMESTER
COLLEGE OF PHYSICAL THERAPY
GC UNIVERSITY FAISALABAD

Clinical log book

Student’s name: _________________________________

Roll no: ________________________________

Program: _________________________________

Session: _________________________________

Institute: _________________________________

Student’s address: _______________________________

Student’s Contact No: ____________________________

_________
___________________

Clinical coordinator
College of
Physical Therapy, GCUF
S.No Date Patient name Age Physical diagnosis Special techniques
intervention
 Assessment form
College of physical therapy GCUF
Department of physical therapy & rehabilitation

Name: S/D/O

Age: Gender: Male/Female

Marital status: Language:

Occupation: Address:

Mode of Admission: Date of Admission:

Medical Diagnosis:

Physical Diagnosis:

History of present illness:

Past medical history:

Personal history:

Family history:

Objective evaluation:
ADL deficiencies:

Posture:
 Lying
 Sitting
 Standing

Pain:
 Onset

 Type/Frequency of Pain: Constant Intermittent Other

 Nature Aching Burning Cramping Crushing Dull Numbness

Pins & Needles Sharp Shooting Throbbing Other, describe :

 Radiating

 Aggravating factor

 Relieving factor
  Severity (VAS)

 Associated symptoms

Inspection:
 Swelling Erythema Joint Deformity Muscle wasting

 ON PALPATION: Temperature Tenderness Edema Inflammatory sign

 Muscle wasting Contractures Crepitations

 ON EXAMINATION

 Range of movement
o Active
o Passive

 Joint Effusion measurement

 Muscle girth

 Limb length

 End feel:

 Capsular

 Non-capsular

MMT:
Specialized test:

Gait assessment

Neurological test

 Dermatomes

 Myotomes

 Reflexes
Lab Test:
 Blood test
 X-ray
 CT scan
 MRI

Management:
Short Term Goals:
1.
2.
3.
Long Term Goals:
 1.
2.
3.
Intervention:

Manual Therapy:
1.
2.
3.
Exercise therapy:
1.
2.
3.

Electrotherapy:
1.
2.
3.

Home plan:
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________

Treatment out Come at the end of the session:

______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
Name of the Student: ______________________________________

Registration No: ______________________________________

Program DPT: ______________________________________

Signature of student: ______________________________________

Supervisor’s Signature