Name: ____________________________________ HRN: __________________________________

Age & Sex: ________________________________

PROBLEM LIST

PROBLEM STARTED RESOLVED

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Clinical Clerk-in-Charge
WVSU Medicine Batch 2019
Name: ____________________________________ HRN: __________________________________
Age & Sex: ________________________________

THERAPEUTIC INDEX
Drug:_____________________________________________________________ Drug:_____________________________________________________________
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CI: _______________________________________________________________ CI: _______________________________________________________________
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SP: _______________________________________________________________ SP: _______________________________________________________________
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AR: ______________________________________________________________ AR: ______________________________________________________________
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DI: _______________________________________________________________ DI: _______________________________________________________________
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SP: _______________________________________________________________ SP: _______________________________________________________________
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DI: _______________________________________________________________ DI: _______________________________________________________________
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Drug:_____________________________________________________________ Drug:_____________________________________________________________
I: ________________________________________________________________ I: ________________________________________________________________
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MOA: _____________________________________________________________ MOA: _____________________________________________________________
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CI: _______________________________________________________________ CI: _______________________________________________________________
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SP: _______________________________________________________________ SP: _______________________________________________________________
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AR: ______________________________________________________________ AR: ______________________________________________________________
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DI: _______________________________________________________________ DI: _______________________________________________________________
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______________________________________________
Clinical Clerk-in-Charge
WVSU Medicine Batch 2019
Name: ____________________________________ HRN: __________________________________
Age & Sex: ________________________________

LABORATORY FLOWSHEET

HEMA CHEM
Hb FBS
Hct BUN
RBC CRE
WBC BCR
Neut UA
Seg CHOL
Stab TAG
Lymph HDL
Eos LDL
Mono Na
Baso K
Platelets Ca
Protime Cl
% Activity ACP
INR ALP
APTT AMS
MCH LD
MCV SGPT
MCHC SGOT
Blood Type Tot. Bili.
B1
URINALYSIS B2
Color Tot. Prot.
Trans Alb
pH Glob
Sp. Grav. A/G
Sugar
Albumin
Pus Cells
RBC FECALYSIS
Casts Color
Consist.
Crystals Occ. Blood
Pus cells
Amorph Urates RBCs
Epith Cells Parasites
Muc. threads
X-ray
UTZ
CT Scan

OTHER LABS:
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Name: ____________________________________ HRN: __________________________________
Age & Sex: ________________________________

Clinical Clerk-in-Charge
WVSU Medicine Batch 2019
CASE DISCUSSION

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________________________________
Clinical Clerk-in-Charge
WVSU Medicine Batch 2019
THERAPEUTIC FLOW CHART
Name: ____________________________________ HRN: __________________________________
Age & Sex: ________________________________

DRUG/MEDICATION STARTED DISCONTINUED

_______________________________
Clinical Clerk-in-Charge
WVSU Medicine Batch 2019