Vous êtes sur la page 1sur 1

UNIVERSITY OF CALIFORNIA, SAN FRANCISCO SCHOOL OF NURSING Department of Community Health Systems Masters Entry Program in Nursing N150: Community Health Nursing Spring 2010

STUDENT W E E K L Y C LINIC A L E XPERIENC E L O G

Date

Week Number

Student's Name

Agency Name

Preceptor Name

Clinical Instructor Name

The following documentation accurately reflects my clinical hours and activities for the week.

DATE TIME ACTIVITY SPENT Write the number(s) of the objective from the Evaluation Sheet (This
DATE
TIME
ACTIVITY
SPENT
Write the number(s) of the objective from
the Evaluation Sheet (This will help you
and your preceptor with your midterm and
final evaluations as well as help focus your
goals for the experience).
Total Hours This Week
Cumulative
Hours to Date

Clinical Instructor Signature

Student Signature

Date

Date

This form must he submitted weekly (on MOODLE). U s e a running do c um e nt that in c lud e s

th e

mo s t r e c e nt s ubtotal of c ompl e t e d c lini c al hour s . At the end of the quarter, pl e a s e print

out

on e c ompl e t e d c opy and s ign it . Review with CI during final evaluation of the clinical

component of the course. This document will be maintained on campus.

N150Spring2010 syllabus updated 3/28/10 printed 3/30/2010

Page 28