DISTRICT RESIDENCY

PROGRAM FOR
POSTGRADUATE
MEDICAL RESIDENTS
Directorate of
Medical Education & Research
Tamil Nadu
Acronyms

DRP : District Residency Program

PIU : Program Implementation Unit
EH : Empanelled Hospital
GMC : Government Medical College
SFMC : Self -Financing Medical College
DU : Deemed University
CHU : Community Health Centers
GCC : Greater Chennai Corporation
NMC : National Medical Commission
ME : Medical Education
MEU : Medical Education Unit
HQ : Head Quarters
MRHRU : Model Rural Health Research Unit
ICMR : Indian Council of Medical Research
CMO : Chief Medical Officer
HS : Hospital Superintendent
JDHS : Joint Director of Medical & Rural Health Service
Format 8: DRP Log Sheets

Directorate of
Medical Education & Research

District Resident Program Activity Record

DRP Empanelled Hospital ____________________________________

Location (District) ____________________________________

Residents Profile
1 Name of the
Postgraduate Resident
2 Age and Date of Birth

3 Department / Specialty

4 Name OF Institute /
Medical College
5 Start Date of Training

6 End Date of Training

 Monthly Activity Record
Area of Posting Date
Name of Supervisor
Date No of OPD No of Inpatients No of Procedures Initials of
Patients seen Assessed Performed Supervisor

Signature of Chief Medical Officer

 Monthly Activity Record
Area of Posting Date
Name of Supervisor
Date No of OPD No of Inpatients No of Procedures Initials of
Patients seen Assessed Performed Supervisor

Signature of Chief Medical Officer

 Monthly Activity Record
Area of Posting Date
Name of Supervisor
Date No of OPD No of Inpatients No of Procedures Initials of
Patients seen Assessed Performed Supervisor

Signature of Chief Medical Officer

 Monthly Activity Record
Area of Posting Date
Name of Supervisor
Date No of OPD No of Inpatients No of Procedures Initials of
Patients seen Assessed Performed Supervisor

Signature of Chief Medical Officer

 Monthly Activity Record
Area of Posting Date
Name of Supervisor
Date No of OPD No of Inpatients No of Procedures Initials of
Patients seen Assessed Performed Supervisor

Signature of Chief Medical Officer

 Monthly Activity Record
Area of Posting Date
Name of Supervisor
Date No of OPD No of Inpatients No of Procedures Initials of
Patients seen Assessed Performed Supervisor

Signature of Chief Medical Officer

 Daily Activity Record
Area of Posting Date
No of Patients seen OPD IP
No Interesting Case Examined Diagnostic Tests Done Treatment Provided

No Procedure Preformed Outcome of Procedure

Synopsis of Learning During the Day : (Discussion of any one patient)

Signature of Chief Medical Officer

 Daily Activity Record
Area of Posting Date

No of Patients seen OPD IP

No Interesting Case Examined Diagnostic Tests Done Treatment Provided

No Procedure Preformed Outcome of Procedure

Synopsis of Learning During the Day : (Discussion of any one patient)

Signature of Chief Medical Officer

 Daily Activity Record
Area of Posting Date

No of Patients seen OPD IP

No Interesting Case Examined Diagnostic Tests Done Treatment Provided

No Procedure Preformed Outcome of Procedure

Synopsis of Learning During the Day : (Discussion of any one patient)

Signature of Chief Medical Officer

 Daily Activity Record
Area of Posting Date

No of Patients seen OPD IP

No Interesting Case Examined Diagnostic Tests Done Treatment Provided

No Procedure Preformed Outcome of Procedure

Synopsis of Learning During the Day : (Discussion of any one patient)

Signature of Chief Medical Officer

 Daily Activity Record
Area of Posting Date

No of Patients seen OPD IP

No Interesting Case Examined Diagnostic Tests Done Treatment Provided

No Procedure Preformed Outcome of Procedure

Synopsis of Learning During the Day : (Discussion of any one patient)

Signature of Chief Medical Officer

 Daily Activity Record
Area of Posting Date
No of Patients seen OPD IP
No Interesting Case Examined Diagnostic Tests Done Treatment Provided

No Procedure Preformed Outcome of Procedure

Synopsis of Learning During the Day : (Discussion of any one patient)

Signature of Chief Medical Officer

 Daily Activity Record
Area of Posting Date
No of Patients seen OPD IP
No Interesting Case Examined Diagnostic Tests Done Treatment Provided

No Procedure Preformed Outcome of Procedure

Synopsis of Learning During the Day : (Discussion of any one patient)

Signature of Chief Medical Officer

 Daily Activity Record
Area of Posting Date
No of Patients seen OPD IP
No Interesting Case Examined Diagnostic Tests Done Treatment Provided

No Procedure Preformed Outcome of Procedure

Synopsis of Learning During the Day : (Discussion of any one patient)

Signature of Chief Medical Officer

 Daily Activity Record
Area of Posting Date
No of Patients seen OPD IP
No Interesting Case Examined Diagnostic Tests Done Treatment Provided

No Procedure Preformed Outcome of Procedure

Synopsis of Learning During the Day : (Discussion of any one patient)

Signature of Chief Medical Officer

 Daily Activity Record
Area of Posting Date
No of Patients seen OPD IP
No Interesting Case Examined Diagnostic Tests Done Treatment Provided

No Procedure Preformed Outcome of Procedure

Synopsis of Learning During the Day : (Discussion of any one patient)

Signature of Chief Medical Officer

 Daily Activity Record
Area of Posting Date
No of Patients seen OPD IP
No Interesting Case Examined Diagnostic Tests Done Treatment Provided

No Procedure Preformed Outcome of Procedure

Synopsis of Learning During the Day : (Discussion of any one patient)

Signature of Chief Medical Officer

 Daily Activity Record
Area of Posting Date
No of Patients seen OPD IP
No Interesting Case Examined Diagnostic Tests Done Treatment Provided

No Procedure Preformed Outcome of Procedure

Synopsis of Learning During the Day : (Discussion of any one patient)

Signature of Chief Medical Officer

 Daily Activity Record
Area of Posting Date
No of Patients seen OPD IP
No Interesting Case Examined Diagnostic Tests Done Treatment Provided

No Procedure Preformed Outcome of Procedure

Synopsis of Learning During the Day : (Discussion of any one patient)

Signature of Chief Medical Officer

 Daily Activity Record
Area of Posting Date
No of Patients seen OPD IP
No Interesting Case Examined Diagnostic Tests Done Treatment Provided

No Procedure Preformed Outcome of Procedure

Synopsis of Learning During the Day : (Discussion of any one patient)

Signature of Chief Medical Officer

 Daily Activity Record
Area of Posting Date
No of Patients seen OPD IP
No Interesting Case Examined Diagnostic Tests Done Treatment Provided

No Procedure Preformed Outcome of Procedure

Synopsis of Learning During the Day : (Discussion of any one patient)

Signature of Chief Medical Officer

 Daily Activity Record
Area of Posting Date
No of Patients seen OPD IP
No Interesting Case Examined Diagnostic Tests Done Treatment Provided

No Procedure Preformed Outcome of Procedure

Synopsis of Learning During the Day : (Discussion of any one patient)

Signature of Chief Medical Officer

 Daily Activity Record
Area of Posting Date
No of Patients seen OPD IP
No Interesting Case Examined Diagnostic Tests Done Treatment Provided

No Procedure Preformed Outcome of Procedure

Synopsis of Learning During the Day : (Discussion of any one patient)

Signature of Chief Medical Officer

 Daily Activity Record
Area of Posting Date
No of Patients seen OPD IP
No Interesting Case Examined Diagnostic Tests Done Treatment Provided

No Procedure Preformed Outcome of Procedure

Synopsis of Learning During the Day : (Discussion of any one patient)

Signature of Chief Medical Officer

 Daily Activity Record
Area of Posting Date
No of Patients seen OPD IP
No Interesting Case Examined Diagnostic Tests Done Treatment Provided

No Procedure Preformed Outcome of Procedure

Synopsis of Learning During the Day : (Discussion of any one patient)

Signature of Chief Medical Officer

 Daily Activity Record
Area of Posting Date
No of Patients seen OPD IP
No Interesting Case Examined Diagnostic Tests Done Treatment Provided

No Procedure Preformed Outcome of Procedure

Synopsis of Learning During the Day : (Discussion of any one patient)

Signature of Chief Medical Officer

 Daily Activity Record
Area of Posting Date
No of Patients seen OPD IP
No Interesting Case Examined Diagnostic Tests Done Treatment Provided

No Procedure Preformed Outcome of Procedure

Synopsis of Learning During the Day : (Discussion of any one patient)

Signature of Chief Medical Officer

 Daily Activity Record
Area of Posting Date
No of Patients seen OPD IP
No Interesting Case Examined Diagnostic Tests Done Treatment Provided

No Procedure Preformed Outcome of Procedure

Synopsis of Learning During the Day : (Discussion of any one patient)

Signature of Chief Medical Officer

 Daily Activity Record
Area of Posting Date
No of Patients seen OPD IP
No Interesting Case Examined Diagnostic Tests Done Treatment Provided

No Procedure Preformed Outcome of Procedure

Synopsis of Learning During the Day : (Discussion of any one patient)

Signature of Chief Medical Officer

 Daily Activity Record
Area of Posting Date
No of Patients seen OPD IP
No Interesting Case Examined Diagnostic Tests Done Treatment Provided

No Procedure Preformed Outcome of Procedure

Synopsis of Learning During the Day : (Discussion of any one patient)

Signature of Chief Medical Officer

 Daily Activity Record
Area of Posting Date
No of Patients seen OPD IP
No Interesting Case Examined Diagnostic Tests Done Treatment Provided

No Procedure Preformed Outcome of Procedure

Synopsis of Learning During the Day : (Discussion of any one patient)

Signature of Chief Medical Officer

 Daily Activity Record
Area of Posting Date
No of Patients seen OPD IP
No Interesting Case Examined Diagnostic Tests Done Treatment Provided

No Procedure Preformed Outcome of Procedure

Synopsis of Learning During the Day : (Discussion of any one patient)

Signature of Chief Medical Officer

 Daily Activity Record
Area of Posting Date
No of Patients seen OPD IP
No Interesting Case Examined Diagnostic Tests Done Treatment Provided

No Procedure Preformed Outcome of Procedure

Synopsis of Learning During the Day : (Discussion of any one patient)

Signature of Chief Medical Officer

 Daily Activity Record
Area of Posting Date
No of Patients seen OPD IP
No Interesting Case Examined Diagnostic Tests Done Treatment Provided

No Procedure Preformed Outcome of Procedure

Synopsis of Learning During the Day : (Discussion of any one patient)

Signature of Chief Medical Officer

 Daily Activity Record
Area of Posting Date
No of Patients seen OPD IP
No Interesting Case Examined Diagnostic Tests Done Treatment Provided

No Procedure Preformed Outcome of Procedure

Synopsis of Learning During the Day : (Discussion of any one patient)

Signature of Chief Medical Officer

 Daily Activity Record
Area of Posting Date
No of Patients seen OPD IP
No Interesting Case Examined Diagnostic Tests Done Treatment Provided

No Procedure Preformed Outcome of Procedure

Synopsis of Learning During the Day : (Discussion of any one patient)

Signature of Chief Medical Officer

 Daily Activity Record
Area of Posting Date
No of Patients seen OPD IP
No Interesting Case Examined Diagnostic Tests Done Treatment Provided

No Procedure Preformed Outcome of Procedure

Synopsis of Learning During the Day : (Discussion of any one patient)

Signature of Chief Medical Officer

 Daily Activity Record
Area of Posting Date
No of Patients seen OPD IP
No Interesting Case Examined Diagnostic Tests Done Treatment Provided

No Procedure Preformed Outcome of Procedure

Synopsis of Learning During the Day : (Discussion of any one patient)

Signature of Chief Medical Officer

 Daily Activity Record
Area of Posting Date
No of Patients seen OPD IP
No Interesting Case Examined Diagnostic Tests Done Treatment Provided

No Procedure Preformed Outcome of Procedure

Synopsis of Learning During the Day : (Discussion of any one patient)

Signature of Chief Medical Officer

 Daily Activity Record
Area of Posting Date
No of Patients seen OPD IP
No Interesting Case Examined Diagnostic Tests Done Treatment Provided

No Procedure Preformed Outcome of Procedure

Synopsis of Learning During the Day : (Discussion of any one patient)

Signature of Chief Medical Officer

 Daily Activity Record
Area of Posting Date
No of Patients seen OPD IP
No Interesting Case Examined Diagnostic Tests Done Treatment Provided

No Procedure Preformed Outcome of Procedure

Synopsis of Learning During the Day : (Discussion of any one patient)

Signature of Chief Medical Officer

 Daily Activity Record
Area of Posting Date
No of Patients seen OPD IP
No Interesting Case Examined Diagnostic Tests Done Treatment Provided

No Procedure Preformed Outcome of Procedure

Synopsis of Learning During the Day : (Discussion of any one patient)

Signature of Chief Medical Officer

 Daily Activity Record
Area of Posting Date
No of Patients seen OPD IP
No Interesting Case Examined Diagnostic Tests Done Treatment Provided

No Procedure Preformed Outcome of Procedure

Synopsis of Learning During the Day : (Discussion of any one patient)

Signature of Chief Medical Officer

 Daily Activity Record
Area of Posting Date
No of Patients seen OPD IP
No Interesting Case Examined Diagnostic Tests Done Treatment Provided

No Procedure Preformed Outcome of Procedure

Synopsis of Learning During the Day : (Discussion of any one patient)

Signature of Chief Medical Officer

 Daily Activity Record
Area of Posting Date
No of Patients seen OPD IP
No Interesting Case Examined Diagnostic Tests Done Treatment Provided

No Procedure Preformed Outcome of Procedure

Synopsis of Learning During the Day : (Discussion of any one patient)

Signature of Chief Medical Officer

 Daily Activity Record
Area of Posting Date
No of Patients seen OPD IP
No Interesting Case Examined Diagnostic Tests Done Treatment Provided

No Procedure Preformed Outcome of Procedure

Synopsis of Learning During the Day : (Discussion of any one patient)

Signature of Chief Medical Officer

 Daily Activity Record
Area of Posting Date
No of Patients seen OPD IP
No Interesting Case Examined Diagnostic Tests Done Treatment Provided

No Procedure Preformed Outcome of Procedure

Synopsis of Learning During the Day : (Discussion of any one patient)

Signature of Chief Medical Officer

 Daily Activity Record
Area of Posting Date
No of Patients seen OPD IP
No Interesting Case Examined Diagnostic Tests Done Treatment Provided

No Procedure Preformed Outcome of Procedure

Synopsis of Learning During the Day : (Discussion of any one patient)

Signature of Chief Medical Officer

 Daily Activity Record
Area of Posting Date
No of Patients seen OPD IP
No Interesting Case Examined Diagnostic Tests Done Treatment Provided

No Procedure Preformed Outcome of Procedure

Synopsis of Learning During the Day : (Discussion of any one patient)

Signature of Chief Medical Officer

 Daily Activity Record
Area of Posting Date
No of Patients seen OPD IP
No Interesting Case Examined Diagnostic Tests Done Treatment Provided

No Procedure Preformed Outcome of Procedure

Synopsis of Learning During the Day : (Discussion of any one patient)

Signature of Chief Medical Officer

 Daily Activity Record
Area of Posting Date
No of Patients seen OPD IP
No Interesting Case Examined Diagnostic Tests Done Treatment Provided

No Procedure Preformed Outcome of Procedure

Synopsis of Learning During the Day : (Discussion of any one patient)

Signature of Chief Medical Officer

 Daily Activity Record
Area of Posting Date
No of Patients seen OPD IP
No Interesting Case Examined Diagnostic Tests Done Treatment Provided

No Procedure Preformed Outcome of Procedure

Synopsis of Learning During the Day : (Discussion of any one patient)

Signature of Chief Medical Officer

 Daily Activity Record
Area of Posting Date
No of Patients seen OPD IP
No Interesting Case Examined Diagnostic Tests Done Treatment Provided

No Procedure Preformed Outcome of Procedure

Synopsis of Learning During the Day : (Discussion of any one patient)

Signature of Chief Medical Officer

 Daily Activity Record
Area of Posting Date
No of Patients seen OPD IP
No Interesting Case Examined Diagnostic Tests Done Treatment Provided

No Procedure Preformed Outcome of Procedure

Synopsis of Learning During the Day : (Discussion of any one patient)

Signature of Chief Medical Officer

 Daily Activity Record
Area of Posting Date
No of Patients seen OPD IP
No Interesting Case Examined Diagnostic Tests Done Treatment Provided

No Procedure Preformed Outcome of Procedure

Synopsis of Learning During the Day : (Discussion of any one patient)

Signature of Chief Medical Officer

 Daily Activity Record
Area of Posting Date
No of Patients seen OPD IP
No Interesting Case Examined Diagnostic Tests Done Treatment Provided

No Procedure Preformed Outcome of Procedure

Synopsis of Learning During the Day : (Discussion of any one patient)

Signature of Chief Medical Officer

 Daily Activity Record
Area of Posting Date
No of Patients seen OPD IP
No Interesting Case Examined Diagnostic Tests Done Treatment Provided

No Procedure Preformed Outcome of Procedure

Synopsis of Learning During the Day : (Discussion of any one patient)

Signature of Chief Medical Officer

 Daily Activity Record
Area of Posting Date
No of Patients seen OPD IP
No Interesting Case Examined Diagnostic Tests Done Treatment Provided

No Procedure Preformed Outcome of Procedure

Synopsis of Learning During the Day : (Discussion of any one patient)

Signature of Chief Medical Officer

 Daily Activity Record
Area of Posting Date
No of Patients seen OPD IP
No Interesting Case Examined Diagnostic Tests Done Treatment Provided

No Procedure Preformed Outcome of Procedure

Synopsis of Learning During the Day : (Discussion of any one patient)

Signature of Chief Medical Officer

 Daily Activity Record
Area of Posting Date
No of Patients seen OPD IP
No Interesting Case Examined Diagnostic Tests Done Treatment Provided

No Procedure Preformed Outcome of Procedure

Synopsis of Learning During the Day : (Discussion of any one patient)

Signature of Chief Medical Officer

 Daily Activity Record
Area of Posting Date
No of Patients seen OPD IP
No Interesting Case Examined Diagnostic Tests Done Treatment Provided

No Procedure Preformed Outcome of Procedure

Synopsis of Learning During the Day : (Discussion of any one patient)

Signature of Chief Medical Officer

 Daily Activity Record
Area of Posting Date
No of Patients seen OPD IP
No Interesting Case Examined Diagnostic Tests Done Treatment Provided

No Procedure Preformed Outcome of Procedure

Synopsis of Learning During the Day : (Discussion of any one patient)

Signature of Chief Medical Officer

 Daily Activity Record
Area of Posting Date
No of Patients seen OPD IP
No Interesting Case Examined Diagnostic Tests Done Treatment Provided

No Procedure Preformed Outcome of Procedure

Synopsis of Learning During the Day : (Discussion of any one patient)

Signature of Chief Medical Officer

 Daily Activity Record
Area of Posting Date
No of Patients seen OPD IP
No Interesting Case Examined Diagnostic Tests Done Treatment Provided

No Procedure Preformed Outcome of Procedure

Synopsis of Learning During the Day : (Discussion of any one patient)

Signature of Chief Medical Officer

 Daily Activity Record
Area of Posting Date
No of Patients seen OPD IP
No Interesting Case Examined Diagnostic Tests Done Treatment Provided

No Procedure Preformed Outcome of Procedure

Synopsis of Learning During the Day : (Discussion of any one patient)

Signature of Chief Medical Officer

 Daily Activity Record
Area of Posting Date
No of Patients seen OPD IP
No Interesting Case Examined Diagnostic Tests Done Treatment Provided

No Procedure Preformed Outcome of Procedure

Synopsis of Learning During the Day : (Discussion of any one patient)

Signature of Chief Medical Officer

 Daily Activity Record
Area of Posting Date
No of Patients seen OPD IP
No Interesting Case Examined Diagnostic Tests Done Treatment Provided

No Procedure Preformed Outcome of Procedure

Synopsis of Learning During the Day : (Discussion of any one patient)

Signature of Chief Medical Officer

 Daily Activity Record
Area of Posting Date
No of Patients seen OPD IP
No Interesting Case Examined Diagnostic Tests Done Treatment Provided

No Procedure Preformed Outcome of Procedure

Synopsis of Learning During the Day : (Discussion of any one patient)

Signature of Chief Medical Officer

 Daily Activity Record
Area of Posting Date
No of Patients seen OPD IP
No Interesting Case Examined Diagnostic Tests Done Treatment Provided

No Procedure Preformed Outcome of Procedure

Synopsis of Learning During the Day : (Discussion of any one patient)

Signature of Chief Medical Officer

 Daily Activity Record
Area of Posting Date
No of Patients seen OPD IP
No Interesting Case Examined Diagnostic Tests Done Treatment Provided

No Procedure Preformed Outcome of Procedure

Synopsis of Learning During the Day : (Discussion of any one patient)

Signature of Chief Medical Officer

 Daily Activity Record
Area of Posting Date
No of Patients seen OPD IP
No Interesting Case Examined Diagnostic Tests Done Treatment Provided

No Procedure Preformed Outcome of Procedure

Synopsis of Learning During the Day : (Discussion of any one patient)

Signature of Chief Medical Officer

 Daily Activity Record
Area of Posting Date
No of Patients seen OPD IP
No Interesting Case Examined Diagnostic Tests Done Treatment Provided

No Procedure Preformed Outcome of Procedure

Synopsis of Learning During the Day : (Discussion of any one patient)

Signature of Chief Medical Officer

 Daily Activity Record
Area of Posting Date
No of Patients seen OPD IP
No Interesting Case Examined Diagnostic Tests Done Treatment Provided

No Procedure Preformed Outcome of Procedure

Synopsis of Learning During the Day : (Discussion of any one patient)

Signature of Chief Medical Officer

 Daily Activity Record
Area of Posting Date
No of Patients seen OPD IP
No Interesting Case Examined Diagnostic Tests Done Treatment Provided

No Procedure Preformed Outcome of Procedure

Synopsis of Learning During the Day : (Discussion of any one patient)

Signature of Chief Medical Officer

 Daily Activity Record
Area of Posting Date
No of Patients seen OPD IP
No Interesting Case Examined Diagnostic Tests Done Treatment Provided

No Procedure Preformed Outcome of Procedure

Synopsis of Learning During the Day : (Discussion of any one patient)

Signature of Chief Medical Officer

 Daily Activity Record
Area of Posting Date
No of Patients seen OPD IP
No Interesting Case Examined Diagnostic Tests Done Treatment Provided

No Procedure Preformed Outcome of Procedure

Synopsis of Learning During the Day : (Discussion of any one patient)

Signature of Chief Medical Officer

 Daily Activity Record
Area of Posting Date
No of Patients seen OPD IP
No Interesting Case Examined Diagnostic Tests Done Treatment Provided

No Procedure Preformed Outcome of Procedure

Synopsis of Learning During the Day : (Discussion of any one patient)

Signature of Chief Medical Officer

 Daily Activity Record
Area of Posting Date
No of Patients seen OPD IP
No Interesting Case Examined Diagnostic Tests Done Treatment Provided

No Procedure Preformed Outcome of Procedure

Synopsis of Learning During the Day : (Discussion of any one patient)

Signature of Chief Medical Officer

 Daily Activity Record
Area of Posting Date
No of Patients seen OPD IP
No Interesting Case Examined Diagnostic Tests Done Treatment Provided

No Procedure Preformed Outcome of Procedure

Synopsis of Learning During the Day : (Discussion of any one patient)

Signature of Chief Medical Officer

 Daily Activity Record
Area of Posting Date
No of Patients seen OPD IP
No Interesting Case Examined Diagnostic Tests Done Treatment Provided

No Procedure Preformed Outcome of Procedure

Synopsis of Learning During the Day : (Discussion of any one patient)

Signature of Chief Medical Officer

 Daily Activity Record
Area of Posting Date
No of Patients seen OPD IP
No Interesting Case Examined Diagnostic Tests Done Treatment Provided

No Procedure Preformed Outcome of Procedure

Synopsis of Learning During the Day : (Discussion of any one patient)

Signature of Chief Medical Officer

 Daily Activity Record
Area of Posting Date
No of Patients seen OPD IP
No Interesting Case Examined Diagnostic Tests Done Treatment Provided

No Procedure Preformed Outcome of Procedure

Synopsis of Learning During the Day : (Discussion of any one patient)

Signature of Chief Medical Officer

 Daily Activity Record
Area of Posting Date
No of Patients seen OPD IP
No Interesting Case Examined Diagnostic Tests Done Treatment Provided

No Procedure Preformed Outcome of Procedure

Synopsis of Learning During the Day : (Discussion of any one patient)

Signature of Chief Medical Officer

 Daily Activity Record
Area of Posting Date
No of Patients seen OPD IP
No Interesting Case Examined Diagnostic Tests Done Treatment Provided

No Procedure Preformed Outcome of Procedure

Synopsis of Learning During the Day : (Discussion of any one patient)

Signature of Chief Medical Officer

 Daily Activity Record
Area of Posting Date
No of Patients seen OPD IP
No Interesting Case Examined Diagnostic Tests Done Treatment Provided

No Procedure Preformed Outcome of Procedure

Synopsis of Learning During the Day : (Discussion of any one patient)

Signature of Chief Medical Officer

 Daily Activity Record
Area of Posting Date
No of Patients seen OPD IP
No Interesting Case Examined Diagnostic Tests Done Treatment Provided

No Procedure Preformed Outcome of Procedure

Synopsis of Learning During the Day : (Discussion of any one patient)

Signature of Chief Medical Officer

 Daily Activity Record
Area of Posting Date
No of Patients seen OPD IP
No Interesting Case Examined Diagnostic Tests Done Treatment Provided

No Procedure Preformed Outcome of Procedure

Synopsis of Learning During the Day : (Discussion of any one patient)

Signature of Chief Medical Officer

 Daily Activity Record
Area of Posting Date
No of Patients seen OPD IP
No Interesting Case Examined Diagnostic Tests Done Treatment Provided

No Procedure Preformed Outcome of Procedure

Synopsis of Learning During the Day : (Discussion of any one patient)

Signature of Chief Medical Officer

 Daily Activity Record
Area of Posting Date
No of Patients seen OPD IP
No Interesting Case Examined Diagnostic Tests Done Treatment Provided

No Procedure Preformed Outcome of Procedure

Synopsis of Learning During the Day : (Discussion of any one patient)

Signature of Chief Medical Officer

 Daily Activity Record
Area of Posting Date
No of Patients seen OPD IP
No Interesting Case Examined Diagnostic Tests Done Treatment Provided

No Procedure Preformed Outcome of Procedure

Synopsis of Learning During the Day : (Discussion of any one patient)

Signature of Chief Medical Officer

 Daily Activity Record
Area of Posting Date
No of Patients seen OPD IP
No Interesting Case Examined Diagnostic Tests Done Treatment Provided

No Procedure Preformed Outcome of Procedure

Synopsis of Learning During the Day : (Discussion of any one patient)

Signature of Chief Medical Officer

 Daily Activity Record
Area of Posting Date
No of Patients seen OPD IP
No Interesting Case Examined Diagnostic Tests Done Treatment Provided

No Procedure Preformed Outcome of Procedure

Synopsis of Learning During the Day : (Discussion of any one patient)

Signature of Chief Medical Officer

 Daily Activity Record
Area of Posting Date
No of Patients seen OPD IP
No Interesting Case Examined Diagnostic Tests Done Treatment Provided

No Procedure Preformed Outcome of Procedure

Synopsis of Learning During the Day : (Discussion of any one patient)

Signature of Chief Medical Officer

 Daily Activity Record
Area of Posting Date
No of Patients seen OPD IP
No Interesting Case Examined Diagnostic Tests Done Treatment Provided

No Procedure Preformed Outcome of Procedure

Synopsis of Learning During the Day : (Discussion of any one patient)

Signature of Chief Medical Officer

 Daily Activity Record
Area of Posting Date
No of Patients seen OPD IP
No Interesting Case Examined Diagnostic Tests Done Treatment Provided

No Procedure Preformed Outcome of Procedure

Synopsis of Learning During the Day : (Discussion of any one patient)

Signature of Chief Medical Officer

 Daily Activity Record
Area of Posting Date
No of Patients seen OPD IP
No Interesting Case Examined Diagnostic Tests Done Treatment Provided

No Procedure Preformed Outcome of Procedure

Synopsis of Learning During the Day : (Discussion of any one patient)

Signature of Chief Medical Officer

 Daily Activity Record
Area of Posting Date
No of Patients seen OPD IP
No Interesting Case Examined Diagnostic Tests Done Treatment Provided

No Procedure Preformed Outcome of Procedure

Synopsis of Learning During the Day : (Discussion of any one patient)

Signature of Chief Medical Officer

 Daily Activity Record
Area of Posting Date
No of Patients seen OPD IP
No Interesting Case Examined Diagnostic Tests Done Treatment Provided

No Procedure Preformed Outcome of Procedure

Synopsis of Learning During the Day : (Discussion of any one patient)

Signature of Chief Medical Office

 Procedure Record
Area of Posting Date
Name of Supervisor
No Name of patient & Diagnosis Detail of procedure Initial of
performed Supervisor

Signature of Chief Medical Officer

 Procedure Record
Area of Posting Date
Name of Supervisor
No Name of patient & Diagnosis Detail of procedure Initial of
performed Supervisor

Signature of Chief Medical Officer

 Procedure Record
Area of Posting Date
Name of Supervisor
No Name of patient & Diagnosis Detail of procedure Initial of
performed Supervisor

Signature of Chief Medical Officer

 Procedure Record
Area of Posting Date
Name of Supervisor
No Name of patient & Diagnosis Detail of procedure Initial of
performed Supervisor

Signature of Chief Medical Officer

 Procedure Record
Area of Posting Date
Name of Supervisor
No Name of patient & Diagnosis Detail of procedure Initial of
performed Supervisor

Signature of Chief Medical Officer

 Procedure Record
Area of Posting Date
Name of Supervisor
No Name of patient & Diagnosis Detail of procedure Initial of
performed Supervisor

Signature of Chief Medical Officer

 Procedure Record
Area of Posting Date
Name of Supervisor
No Name of patient & Diagnosis Detail of procedure Initial of
performed Supervisor

Signature of Chief Medical Officer

 Procedure Record
Area of Posting Date
Name of Supervisor
No Name of patient & Diagnosis Detail of procedure Initial of
performed Supervisor

Signature of Chief Medical Officer

 Procedure Record
Area of Posting Date
Name of Supervisor
No Name of patient & Diagnosis Detail of procedure Initial of
performed Supervisor

Signature of Chief Medical Officer

 Procedure Record
Area of Posting Date
Name of Supervisor
No Name of patient & Diagnosis Detail of procedure Initial of
performed Supervisor

Signature of Chief Medical Officer

 Procedure Record
Area of Posting Date
Name of Supervisor
No Name of patient & Diagnosis Detail of procedure Initial of
performed Supervisor

Signature of Chief Medical Officer

 Procedure Record
Area of Posting Date
Name of Supervisor
No Name of patient & Diagnosis Detail of procedure Initial of
performed Supervisor

Signature of Chief Medical Officer

 Procedure Record
Area of Posting Date
Name of Supervisor
No Name of patient & Diagnosis Detail of procedure Initial of
performed Supervisor

Signature of Chief Medical Officer

 Procedure Record
Area of Posting Date
Name of Supervisor
No Name of patient & Diagnosis Detail of procedure Initial of
performed Supervisor

Signature of Chief Medical Officer

 Procedure Record
Area of Posting Date
Name of Supervisor
No Name of patient & Diagnosis Detail of procedure Initial of
performed Supervisor

Signature of Chief Medical Officer

 Procedure Record
Area of Posting Date
Name of Supervisor
No Name of patient & Diagnosis Detail of procedure Initial of
performed Supervisor

Signature of Chief Medical Officer

 Procedure Record
Area of Posting Date
Name of Supervisor
No Name of patient & Diagnosis Detail of procedure Initial of
performed Supervisor

Signature of Chief Medical Officer

 Procedure Record
Area of Posting Date
Name of Supervisor
No Name of patient & Diagnosis Detail of procedure Initial of
performed Supervisor

Signature of Chief Medical Officer

 Procedure Record
Area of Posting Date
Name of Supervisor
No Name of patient & Diagnosis Detail of procedure Initial of
performed Supervisor

Signature of Chief Medical Officer

 Procedure Record
Area of Posting Date
Name of Supervisor
No Name of patient & Diagnosis Detail of procedure Initial of
performed Supervisor

Signature of Chief Medical Officer

 Assessment Record
Area of Date
Posting
Name of
Supervisor
Type of
Assessment 1. Direct Observation of Procedural Skills (DOPS)

2. Mini Clinical Evolution Exercise (Mini CEX)

3. Case Based Discussion ( CbD)

Scoring The Scoring of Assessment to be done on a Scale of 1-5

1. Below Average
2. Average
3. Above Average
4. Good
5. Excellent

No Knowledge/Skill Supervisors Scoring Initial of

Supervisor

Signature of Chief Medical Officer