Grades Committee Member Evaluation of Student Write-up

Student Name:

Date:

Evaluator:

Write Up #:

Patient’s Initials:

Check if fulfilled:

Chief complaint is in the patient’s own words and appropriately detailed

HPI tells a chronologic history of the patient’s chief complaint that begins at baseline state of health

HPI explores the patient’s chief complaint in a way that reveals the student’s working differential diagnosis (Example: if the chief complaint is cough, the HPI should explore symptoms of respiratory infection, obstructive lung disease, rhinitis, esophageal reflux, and cancer)

Past Medical History appropriately detailed, including onset, symptoms, complications and therapy (Example: a diagnosis of coronary disease would include symptom history, previous evaluation and treatment)

Objective data (physical exam, laboratory and other data) supports and further explores the differential diagnosis developed in the HPI (Example: in a patient with syncope the data should include orthostatic vital signs, cardiovascular and neurologic exams, hematocrit, ECG, etc.)

Complete problem list--all problems identified in the history, physical and ancillary testing

Discussion includes a prioritized differential diagnosis for each problem (when appropriate) and is specific to the patient, not simply a summary of the literature.

An appropriate diagnostic and management strategy is discussed for each problem.

Things Done Well:

Student needs to improve:

GRADE:____/15