Dermatology Patient Encounter Direct Observation And Evaluation Form (Page 2 of 3) in pdf

Dermatology Patient Encounter Direct Observation And Evaluation Form Page 2

Dermatology Patient Encounter Direct Observation and Evaluation Form

Date:_______________________________

Resident:____________________________

Circle Year of

PGY‐

Training:

Indicate Specific Changes

Primary Patient Problem: _____________________

Needed To Advance

□

1. Introduction / Asks reason for visit (open ended)

□

2. Directs history of present illness with questions about:

□

Location

Timing

Duration

Context

□

Quality

Treatments

Severity

□

Associated symptoms

□

3. Performs appropriate:

□ Past Medical History (meds & allergy) □ Family History

□ Social History □ Review of Symptoms

□

4. Appropriate pre‐physical examination preparation

(washes hands, gloves, patient in gown/positioned…)

□

5. Examines appropriate organ systems

□

6. Demonstrates appropriate examination skills

□

7. Demonstrates appropriate decision to use specialized

examination techniques (diascopy, dermoscopy, Wood’s

lamp, other)

□

8. Demonstrates appropriate skills using specialized

techniques (diascopy, dermoscopy, Wood’s

lamp, other)

Dermatology Patient Encounter Direct Observation And Evaluation Form Page 2