MEDICAL HISTORY

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SR. No.	Faculty ID	Mentor Name	Student Roll No.	Mentee Name	Remove

STUDENT MEDICAL HISTORY

Academic Performace Tracking

PHASE I

Subject	First Sessional Exam	Second Sessional Exam	Pre university(100+100)		university

PHASE II

Subject	First Sessional Exam	Second Sessional Exam	Pre university(100+100)		university

PHASE III- PART 1

Subject	First Sessional Exam	Second Sessional Exam	Pre university	university	Remarks
Community Medicine
Forensic Medicine
toxicology
ENT
OPYHTHALMOLOGY

PHASE III- PART 2

Subject	First Sessional Exam	Second Sessional Exam	Pre university	university	Remarks
General Medicine
General Surgery
OB&G
Pediatrics

Attendance

Sr. no	Department	Subject Name	Total Lecture	Present	Absent	%age

MENTEE Personal Detail

Mentee Personal Details
Name			Paste recent passport-size photo
Date of Birth
Mobile No.
Date of Joining the Course
Expected Date of Completion
Student Residential Address
City		PIN Code
State		Country
Family Details
Father's Name		Mother's Name
Father's Occupation		Mother's Occupation
Father's Mobile No.		Mother's Mobile No.
Father's Email		Mother's Email
Emergency Contact		Local Guardians
Name		Name
Phone No.		Phone No.
Address		Address
Signature of Parents/Guardians
Father	Mother	Guardian

LOG BOOK MENTOR MENTEE PROGRAM

S.N.	Emp.ID	Faculty Name	Assign Team

Meeting Logs

Sr. no	Date	Time	Attendance	Topics	Obstacles	Strategies	Outcomes	Progress	Mentee	Verified Status	Mentor	Verified Status

Program Evaluation

Sr. no	Mentee's satisfaction with the program 1-5	Suggestions for improvement	Mentee	Verified Status	Mentor	Verified Status

Basic Info.

Stud. Name	Age	Hemoglobin (latest report)	Blood Group

Cheif Complaints

S.No	Id	Complaint Description	OPD	Date

Patient History

S.No	Date	Doctor Name	Married Life	Obs Formula	LMP	EDD	POG	Menstural History	Past History	Family History	Drug Addiction

Clinical Findings

S.No	Id	Clicinical Findings	OPD	Date

Active RX

S.No	Medicine	Frequency

Lab Reports

Patient No	IP/OP	Patient Name	Department	Billed Date	Test Status	PDF.SNO	View PDF	View PDF (Without HDR)

Participation in Professional Development Activities

Sr.No.	Date	Event	Nature of participation	Mentee	Verified Status	Mentor	Verified Status

Participation in college events

Sr.no.	Date	Participation in college events	Mentee	Verified Status	Mentor	Verified Status

Sports/Cultural Achievements

Sr.no.	Date	Sports/Cultural Achievements	Mentee	Verified Status	Mentor	Verified Status