SURGICAL WARD ROTATION

Work Book

JESSA D. TAGUIAM
Name of student

1
 CLINICAL REQUIREMENTS (SURGICAL WARD)

RUBRICS FOR REQUIREMENTS

CRITERIA RATING
Observation contain best are well-
selected and very substantial 91-100
Submitted ahead of/on schedule
Observation contain better details, are
well-selected and substantial 81-90
Submitted ahead of/on schedule
Observation contain acceptable details,
are well-selected and substantial 71-80
Submitted ahead of/on schedule
Observations contain few details and
minimal substance 61-70
Submitted within 3-12 hours after
scheduled time
Observation contain acceptable details,
limitedly selected with minimal 50-60
substance
Submitted within 12-24 hours after
scheduled time
Observation contain few details, are not
well-selected and have very minimal
substance <50
Submitted within 12-24 hours after
scheduled time
No entry, with fewer words or sentences
Submitted after 36 hours after scheduled 0
time

REQUIREMENTS RATING SUGGESTIONS FOR

IMPROVEMENT
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
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15.
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17.
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AVERAGE
QUIZ
Performance Evaluation

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 GENERAL AND SPECIFIC OBJECTIVES (GOSO)
NAME: _____________________________________ DATE: ________________
HOSPITAL: _____________________________________ SHIFT: ________________
CLINICAL INSTRUCTOR: _________________________________ AREA: ________________

GENERAL OBJECTIVES:

SPECIFIC OBJECTIVES:
1.
2.
3.
4.
5.
6.

PLAN OF ACTIVITIES
ACTIVITIES
ST
TIME 1 DAY 2ND DAY

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 HEALTH ASSESSMENT

A. BIOGRAPHICAL DATA

Name: Height (cms):

Age: Weight (kgs):

Sex: Admission date:

Birthdate: Admission time:

Birthplace: Area:

Religion:

Civil Status:

Address:

Nationality:

Ethnic Group:

Occupation:

Admitting Diagnosis:

Admitting Physician:

B. Reason for Seeking Healthcare/Chief Complaints

_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
C. History of Present Illness

_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
D. Past health History

Childhood illnesses
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
Immunizations

_____________________________________________________________________________________
_____________________________________________________________________________________
Surgeries

_____________________________________________________________________________________
_____________________________________________________________________________________
Allergies

_____________________________________________________________________________________
_____________________________________________________________________________________
E. Family Health History
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________