College of Optometry

 

EXTERNSHIP PROGRAM


Instructions/key Assignment Due Dates

Fields marked with * are required.

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

Patient Data From: To:

 
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 ENCOUNTER TYPE
 
COMP FU/VT OBSERVE/
CO-MAN
 
PC (patients older than 18)
 
CL
 
PEDS (patients18 and younger)/BV
Put VT in FU column
 
LV
 
DISEASE (enter EHMS patients)
 
SCREENING (enter in OBSERV column)

NEIGHBORHOOD SITES

Individual Sites
# Patients
Individual Sites
# Patients
Individual Sites
# Patients
Family Care HC Grace Hill HC CHIPS
StL Society Blind People's HC Myrtle Davis HC
Alexian Bros Delmar Gardens SLU Optometry
TLC Laser Center MEC SLAAA MEC Peds
University Eye Center Optometric Center Harvester Eye Care
East St. Louis Eye Center Pepose Vision FOR FUTURE USE

   
  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., Director of Externship Programs (314-516-5603)
Questions? e-mail Yolanda Flanigan, Support Staff for Externship Programs (314-516-5606)

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Webmaster: Dr. Ralph Garzia & Garima Dhawan
Last Updated: May - 10 - 2012