Faculty member:  Attached are the instructions that were provided to the students about this

requirement.  Please review them so you know what was expected of the student. 

Read the medical student’s formal history and physical examination of your patient, along

with the brief monograph the student was to write about the patient’s disease.

 

Identify the pertinent positives and negatives in the history and physical examination

and circle them on that document.  Indicate the number of pertinent positives and

negatives here: _______________________________.

 

Consider any pertinent positives and negatives that are not mentioned in the document and

list those here:

 

Based upon your evaluation of the above data, check one column in each of the following

categories:

 

Item	Excellent	Adequate	Inadequate
Pertinent positives and negatives covered in the history
Pertinent positives and negatives covered in the physical examination

 

Enter your evaluation of the monograph the student wrote on the patient’s disease by

checking one of the columns below:

 

Item	Excellent	Adequate	Inadequate
Quality of the monograph on the patient’s disease

 

Finally, provide any comments you may have regarding the student’s performance of this

requirement: