FINAL ND Module 09-10.pdf - AaronsWorld.com

BASTYR UNIVERSITY’S NATUROPATHIC MEDICINE PRECEPTORSHIP PROGRAM
ND Student’s Clinical Time Sheet
(Be sure to total your hours and patient contacts and have your preceptor initial and sign where applicable on
both sides of this form.)
Student: ___________________________________________________________________________
Preceptor: ________________________________________________________Title: ______________
Date In Out Total Hours Total Patients Preceptor’s Initials
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Total: _________ __________
Optional Comments by Preceptor: ________________________________________________
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Preceptor’s Signature: ___________________________________________ Date: ________________
ND Preceptor Coordinator’s Signature: _______________________________ Date: _______________
revised 8/1/05
~Student Patient Contact Form on reverse~
BASTYR UNIVERSITY’S NATUROPATHIC MEDICINE PRECEPTORSHIP PROGRAM
ND Student’s Preceptorship Patient Contacts
Documentation of ALL Patient Contacts is required for credit. Please document your level of participation (Observed,
Assisted, or Performed) under headings in each SOAP (Subjective, Objective, Assessment, and Plan) column.
Do NOT list any patient names or initials.
Student: ____________________________________________________________________________
Preceptor: _______________________________________________________ Title: ______________
Preceptor’s Initials
Date Medical Assessment S O A P
revised 8/1/05
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