INTERNAL MEDICINE Savannah CLERKSHIP MANUAL

MERCER UNIVERSITY SCHOOL OF MEDICINE
Department of Internal Medicine Junior Medical Students
WEEKLY WORK HOURS/PROCEDURE LOG FORM
DATE/# HRS WORKED TIME OF DAY WORKED PROCEDURE(S) PERFORMED
MON
AM to PM
Number of hours: Night float name if applicable:
DATE/# HRS WORKED TIME OF DAY WORKED PROCEDURE(S) PERFORMED
TUES
AM to PM
Number of hours: Night float name if applicable:
DATE/# HRS WORKED TIME OF DAY WORKED PROCEDURE(S) PERFORMED
WED
AM to PM
Number of hours: Night float name if applicable:
DATE/# HRS WORKED TIME OF DAY WORKED PROCEDURE(S) PERFORMED
THURS
AM to PM
Number of hours Night float name if applicable:
DATE/# HRS WORKED TIME OF DAY WORKED PROCEDURE(S) PERFORMED
FRI
AM to PM
Number of hours: Night float name if applicable:
DATE/# HRS WORKED TIME OF DAY WORKED PROCEDURE(S) PERFORMED
SAT
AM to PM
Number of hours: Night float name if applicable:
DATE/# HRS WORKED TIME OF DAY WORKED PROCEDURE(S) PERFORMED
SUN
AM to
PM
Number of hours: Night float name if applicable:
Please circle the proper category for this week. Enter the grand total work hours. Student Signature
REQUIRED
INPATIENT TEAM – Yellow Red Blue Outpatient: Ambulatory – Physician Name (print)
Green Purple
GRAND TOTAL HOURS FOR THE WEEK: Student Signature required:
Print Student Name:
Please circle correct week #: 1 2 3 4 5 6 7 8 9 10 11 12
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