~ Attending Report of Patients Seen ~

Instructions: Use this form to record the number of NECO students assisted and patients seen.

Note: This form works best with Internet Explorer version 6.x or greater. Using other browsers may create unwanted or unexpected results.

If a procedure code is utilized on the super bill the patient should be included in your count. Any patient encounter that does not require a procedure code should not be included in your daily numbers.

Attending Email:

    

Site:

Date:

  

Number of Residents:

   

Number of students:

 2nd Year  
 3rd Year  
 4th Year  


Morning Session:

Afternoon Session:

Evening Session:

Patients Scheduled

Patients Seen

           

Comments: