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    Clinical Log Book: 3 YEAR, Batch IV (2014)

    Uploaded by

    Annie Khan
    The document is a clinical log book and patient assessment form used by physical therapy students. It contains fields to record a patient's name, identifying information, medical history, examination findings, diagnosis, and planned treatment which includes electrotherapy, manual therapy, and other interventions. The form requires signatures from the student and their supervisor.

    Copyright:

    © All Rights Reserved
    Download as DOCX, PDF, TXT or read online from Scribd

    Clinical Log Book: 3 YEAR, Batch IV (2014)

    Uploaded by

    Annie Khan
    32 views4 pages
    The document is a clinical log book and patient assessment form used by physical therapy students. It contains fields to record a patient's name, identifying information, medical history, examination findings, diagnosis, and planned treatment which includes electrotherapy, manual therapy, and other interventions. The form requires signatures from the student and their supervisor.

    Original Description:

    Log Book Third Year

    Original Title

    Log Book Third Year

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    © © All Rights Reserved

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    The document is a clinical log book and patient assessment form used by physical therapy students. It contains fields to record a patient's name, identifying information, medical history, examination findings, diagnosis, and planned treatment which includes electrotherapy, manual therapy, and other interventions. The form requires signatures from the student and their supervisor.

    Copyright:

    © All Rights Reserved
    Download as DOCX, PDF, TXT or read online from Scribd
    Download as docx, pdf, or txt
    32 views4 pages

    Clinical Log Book: 3 YEAR, Batch IV (2014)

    Uploaded by

    Annie Khan
    The document is a clinical log book and patient assessment form used by physical therapy students. It contains fields to record a patient's name, identifying information, medical history, examination findings, diagnosis, and planned treatment which includes electrotherapy, manual therapy, and other interventions. The form requires signatures from the student and their supervisor.

    Copyright:

    © All Rights Reserved
    Download as DOCX, PDF, TXT or read online from Scribd
    Download as docx, pdf, or txt
    of 4

    ZIAUDDIN COLLEGE OF PHYSICAL THERAPY

    ZIAUDDIN UNIVERSITY

    Clinical Log Book

    DOCTOR OF PHYSICAL THERAPY


    3RD YEAR, Batch IV (2014)

    Student`s Name: ___________________________________________

    Enrollment number: ________________________________________


    Patient Assessment form
    Name: ____________________________ MR No: __________ Gender: ________ Age: _____ Occupation:
    _____________________ Referral/Doctor: ______________________________

    Address: _____________________________________________________________________

    Subjective Information:

    ________________________________________________________________________________________
    ________________________________________________________________________________________
    ________________________________________________________________________________________
    ________________________________________________________________________________________
    ________________________________________________________________________________________
    ____________________________

    Provisional Diagnosis:
    Objective Information:

    ________________________________________________________________________________________
    ________________________________________________________________________________________
    ________________________________________________________________________________________
    ________________________________________________________________________________________
    ________________________________________________________________________________________
    ________________________________________________________________________________________
    __________________

    Differential Diagnosis:

    Examination:

    ________________________________________________________________________________________
    ________________________________________________________________________________________
    ________________________________________________________________________________________
    ________________________________________________________________________________________
    ________________________________________________________________________________________
    ____________________________

    Laboratory/Radiological Investigation:

    ________________________________________________________________________________________
    ________________________________________________________________________________________
    __________________________________________________________

    Diagnosis:
    Treatment Plan:

    Electrotherapy:

    ________________________________________________________________________________________
    ________________________________________________________________________________________
    ________________________________________________________________________________________
    ________________________________________________________________________________________
    ______________________________________

    Manual Therapy:

    ________________________________________________________________________________________
    ________________________________________________________________________________________
    ________________________________________________________________________________________
    ________________________________________________________________________________________
    ________________________________________________________________________________________
    ____________________________

    Others:

    ________________________________________________________________________________________
    ________________________________________________________________________________________
    ________________________________________________________________________________________
    ________________________________________________

    Outcomes/Prognosis:

    ________________________________________________________________________________________
    ________________________________________________________________________________________
    ________________________________________________________________________________________
    ________________________________________________

    _____________________ _____________________

    Signature supervisor Student signature

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