College of Optometry Header

 

EXTERNSHIP PROGRAM


Instructions/key Assignment Due Dates

Fields marked with * are required.

Name of Site*
Attending Doctor*
Extern*
Graduation Year*
Extern e-mail address* (UMSL e-mail Id required)
Term*

Patient Data From: Please select the date To: Please select the date

 
AGE # patients
0-18
19-39
40-64
65 -

Note: Please include the number of individual patient observations and patients screened in these totals above. The table above should contain the total number of patients that you have seen. These data are then detailed in the table at the right.>>>>>>>>>

The totals in the 2 tables must be the same.
PATIENT COMP ENCOUNTER FU TYPE OBSERVE
 
PC (patients older than 18)
 
CL
 
PEDS (patients18 and younger)/BV
 
LV
 
DISEASE (enter EHMS patients)
 
SCREENING (enter in OBSERV column)

   
  PRIMARY DIAGNOSES- max 3/patient
Refractive error 367
Eyelid/lacrimal 373/375
Conjunctivitis 372
Cornea 371
Iris/ciliary body 364
Glaucoma 365
Lens/vitreous 366/379
Retina/choroid 361/363
Oculomotor 378
Globe/orbit 360
Neuro-ophth 377
 
 TREATMENTS -max 3/patient
SPEC
CL
VT
LV
Rx MEDS
OTC MEDS
LASER(pre&post testing)
INJECTABLES
REFERRAL
OTHER

Questions? e-mail Alex Harris O.D., Coordinator of Externship Programs (314-516-5603) Questions? e-mail Yolanda Flanigan, Support Staff for Externship Programs (314-516-5606)

Remember to submit your case reports electronically here

Webmaster: Dr. Ralph Garzia & Sharon Rose J
Last Updated: September - 20 - 2007