DAILY CLERKSHIP

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Student's full name

Class

Ward's Name and Number

Patient's Registration number

Patient's demographics

Chief complaint

History of presenting illness (HPI)

Review of other systems

Past obstetric history

Past gynecological history

Past medical history

Family social history

General examination

Systemic examination

Summary

Provisional diagnosis

Differential diagnosis

Investigations

Treatment plan

Follow up plan

Prognosis

Preventive measures

Patients summary of management plan based on daily ward rounds.(kindly include investigation results and decisions)