Other Required Forms
All students must complete the following forms and turn them in at the debriefing/evaluation session, which is held on the last day of the clerkship. All forms are located in Section II on pages 15-26. The log forms help us monitor the quality of the clerkship experience. To ensure the accuracy of the data and to avoid getting overwhelmed, we recommend you do the data entry on a daily basis.
- Complete the Pre & Post Clerkship Assessment form following the directions (pages 15-16).
- Log the Core Topic Requirements for Patient Encounters (page 7) on New Innovations. Print out a final report of your procedures from New Innovations and turn in with all other assignments at the debriefing/evaluation session.
- Spend a minimum of one-half day during the month with one community resource person/agency and complete the Agency Summary Information from (page 17) for this experience. The community agency should provide care to underserved/at risk populations.
- Complete the Faculty-Observed Back Examination form (pages 18-19). Form must be signed by faculty who has observed and reviewed the experience with you.
- Complete the Clerkship Mid-Cycle Feedback form (page 20).
- Complete the Pennsylvania AHEC Clinical Report Form (Exit) CR-2 (pages 21-24).
All assignments, forms, duty hour and case logger reports are due at the beginning of the debriefing session, which is held on the last day of the clerkship beginning at 7:45 a.m.