UST Faculty of Medicine and Surgery

Department of Ophthalmology
JUINIOR INTERNSHIP GRADING SHEET

Junior Accuracy- Made a concise and accurate (2pts) Intern: ATANACIO,

Mariel Joy
history
Date
Completeness- Asked all pertinent (2pts)
of Rotation: APRIL 16-
questions
23, Completeness- Did pertinent tests (2pts) 2017
Presentation- Presented organized (1pt)
Accuracy-
thoughts, Made accurate observations (3pt)
I. MINI REVALIDA
proper language
Arrived and form
at a reasonable diagnosis and (2pts) History
differentials Taking
Discussed case with sufficient (3pt) (5pts)
background knowledge

1stfundoscop 2ndfundoscopy
y
Index finger on dialing knob (1 pt)
Proper hand and eye positioning
(3pts)
Checks for ROR and compares
bilaterally (3pts)
Reports description of fundus findings
(3 pts)

Eye Exam (5pts)

Discussion (5pts)

Fundoscopy (5pts) 5pts _________

_______________________
CONSULTANTs
SIGNATURE

II. FUNDOSCOPY

III. EMERGENCIES __________________

 IV. OPERATING ROOM ROTATION __________________

UST: A002-17-FO01

Mini Revalida (20%)

Fundoscopy (20%)
Ophtha Emergencies
(20%)
Quiz (20%)
Attendance (10%)
Participation (10%)
TOTAL
(100%)
 UST Faculty of Medicine and Surgery
Department of Ophthalmology
JUINIOR INTERNSHIP GRADING SHEET

Junior Accuracy- Made a concise and accurate (2pts) Intern: BAUTISTA,

history Micaela
Completeness- Asked all pertinent (2pts) Date
of questions Rotation: APRIL 16-
23, Completeness- Did pertinent tests (2pts) 2017
Presentation- Presented organized (1pt)
Accuracy-
thoughts, Made accurate observations (3pt)
I. MINI REVALIDA
proper language
Arrived and form
at a reasonable diagnosis and (2pts) History
differentials Taking
Discussed case with sufficient (3pt) (5pts)
background knowledge

1stfundoscop 2ndfundoscopy
y
Index finger on dialing knob (1 pt)
Proper hand and eye positioning
(3pts)
Checks for ROR and compares
bilaterally (3pts)
Reports description of fundus findings
(3 pts)

Eye Exam (5pts)

Discussion (5pts)

Fundoscopy (5pts) 5pts _________

_______________________
CONSULTANTs
SIGNATURE

II. FUNDOSCOPY

III. EMERGENCIES __________________

 IV. OPERATING ROOM ROTATION __________________

Accuracy- Made a concise and accurate (2pts)

history
Completeness- Asked all pertinent (2pts)
questions
Completeness- Did pertinent
Presentation- Presented tests
organized (2pts)
(1pt)
Accuracy-
thoughts, Made accurate observations (3pt)
proper language
Arrived and form
at a reasonable diagnosis and (2pts)
UST: A002-17-FO01
UST differentials Faculty of
Discussed case with sufficient (3pt) Medicine and
background knowledge Surgery
Department of Ophthalmology
JUINIOR INTERNSHIP GRADING SHEET

Junior Intern: LEE, Ha Young Date of Rotation:

APRIL 16-23, 2017

I. MINI REVALIDA
History Taking (5pts)
Mini Revalida (20%)
Fundoscopy (20%)
Ophtha Emergencies
(20%)
Quiz (20%)
Attendance (10%)
Eye Exam (5pts)
Participation (10%)
TOTAL
(100%)

Discussion (5pts)

Fundoscopy (5pts) 5pts _________

_______________________
CONSULTANTs
SIGNATURE

II. FUNDOSCOPY
 Accuracy- Made a concise and accurate (2pts)
history
III. Completeness- Asked all pertinent (2pts) EMERGENCIES
questions
Completeness- Did pertinent
Presentation- Presented tests
organized (2pts)
(1pt)
Accuracy- __________________
thoughts, Made accurate observations (3pt)
proper language
Arrived and form
at a reasonable diagnosis and (2pts)
IV. OPERATING ROOM
differentials ROTATION
Discussed case with sufficient (3pt)
background knowledge __________________

1stfundoscop 2ndfundoscopy
y
Index finger on dialing knob (1 pt)
Proper hand and eye positioning
(3pts)
Checks for ROR and compares
Mini Revalida (20%)bilaterally (3pts)
Reports (20%)
Fundoscopy description of fundus findings UST:
Ophtha Emergencies(3 pts) A002-
(20%) 17-
Quiz (20%) FO01
Attendance (10%)
UST Faculty of Medicine and Surgery
Participation (10%)
TOTAL Department of Ophthalmology
(100%) JUINIOR INTERNSHIP GRADING SHEET

Junior Intern: LIM, Michel Date of Rotation:

APRIL 16-23, 2017

I. MINI REVALIDA
History Taking (5pts)

Eye Exam (5pts)

Discussion (5pts)

Fundoscopy (5pts) 5pts _________

 _______________________
CONSULTANTs
SIGNATURE
Accuracy- Made a concise and accurate (2pts)
history
Completeness- Asked all pertinent (2pts)
II. questions FUNDOSCOPY
Presentation- Presented organized (1pt)
thoughts,
proper language and form

III. EMERGENCIES __________________

IV. OPERA
1stfundoscop 2ndfundoscopy TING
y ROOM
Index finger on dialing knob (1 pt)
Proper hand and eye positioning
(3pts)
Checks for ROR and compares
Mini Revalida (20%)bilaterally (3pts)
Reports (20%)
Fundoscopy description of fundus findings
Ophtha Emergencies(3 pts)
(20%) ROTATION
Quiz (20%) __________________
Attendance (10%)
Participation (10%)
TOTAL
(100%)

UST: A002-17-FO01
UST Faculty of Medicine and Surgery
Department of Ophthalmology
JUINIOR INTERNSHIP GRADING SHEET

Junior Intern: MEDINA, Martha Louise Aurora Date of Rotation:

APRIL 16-23, 2017

I. MINI REVALIDA
History Taking (5pts)
 Eye Exam (5pts)

Discussion (5pts)

Completeness- Did pertinent tests (2pts)

Accuracy- Made accurate observations (3pt) Fundoscopy
(5pts)
Arrived at a reasonable diagnosis and (2pts)
differentials 5pts
Discussed case with sufficient (3pt) _________
background knowledge
_______________________

1stfundoscop 2ndfundoscopy
y
Index finger on dialing knob (1 pt)
Proper hand and eye positioning
(3pts)
Checks for ROR and compares
Mini Revalida (20%)bilaterally (3pts)
Reports (20%)
Fundoscopy description of fundus findings
Ophtha Emergencies(3 pts)
(20%) CONSULTANTs
Quiz (20%) SIGNATURE
Attendance (10%)
Participation (10%)
TOTAL
(100%)
II. FUNDOSCOPY

III. EMERGENCIES __________________

IV. OPERATING ROOM ROTATION __________________

UST: A002-17-FO01
 UST Faculty of Medicine and Surgery
Department of Ophthalmology
JUINIOR INTERNSHIP GRADING SHEET

Junior Accuracy- Made a concise and accurate (2pts) Intern: REYES,

history Patricia Anne
Completeness- Asked all pertinent (2pts)
questions Date of Rotation:
APRIL Completeness- Did pertinent tests (2pts) 16-23, 2017
Presentation- Presented organized (1pt)
Accuracy-
thoughts, Made accurate observations (3pt)
I. MINI REVALIDA
proper language
Arrived and form
at a reasonable diagnosis and (2pts) History
differentials Taking
Discussed case with sufficient (3pt) (5pts)
background knowledge

1stfundoscop 2ndfundoscopy
y
Index finger on dialing knob (1 pt)
Proper hand and eye positioning
(3pts)
Checks for ROR and compares
bilaterally (3pts)
Reports description of fundus findings
(3 pts)

Eye Exam (5pts)

Discussion (5pts)

Fundoscopy (5pts) 5pts _________

_______________________
CONSULTANTs
SIGNATURE

II. FUNDOSCOPY

III. EMERGENCIES __________________

 IV. OPERATING ROOM ROTATION __________________

Accuracy- Made a concise and accurate (2pts)

history
Completeness- Asked all pertinent (2pts)
questions
Completeness- Did pertinent
Presentation- Presented tests
organized (2pts)
(1pt)
Accuracy-
thoughts, Made accurate observations (3pt)
proper language
Arrived and form
at a reasonable diagnosis and (2pts)
UST: A002-17-FO01
UST differentials Faculty of
Discussed case with sufficient (3pt) Medicine and
background knowledge Surgery
Department of Ophthalmology
JUINIOR INTERNSHIP GRADING SHEET

Junior Intern: SOLIS, Ma. Alyanna Kristal Date of Rotation:

APRIL 16-23, 2017

I. MINI REVALIDA
History Taking (5pts)
Mini Revalida (20%)
Fundoscopy (20%)
Ophtha Emergencies
(20%)
Quiz (20%)
Attendance (10%)
Eye Exam (5pts)
Participation (10%)
TOTAL
(100%)

Discussion (5pts)

Fundoscopy (5pts) 5pts _________

_______________________
CONSULTANTs
SIGNATURE

II. FUNDOSCOPY
 Accuracy- Made a concise and accurate (2pts)
history
III. Completeness- Asked all pertinent (2pts) EMERGENCIES
questions
Completeness- Did pertinent
Presentation- Presented tests
organized (2pts)
(1pt)
Accuracy- __________________
thoughts, Made accurate observations (3pt)
proper language
Arrived and form
at a reasonable diagnosis and (2pts)
IV. OPERATING ROOM
differentials ROTATION
Discussed case with sufficient (3pt)
background knowledge __________________

1stfundoscop 2ndfundoscopy
y
Index finger on dialing knob (1 pt)
Proper hand and eye positioning
(3pts)
Checks for ROR and compares
Mini Revalida (20%)bilaterally (3pts)
Reports (20%)
Fundoscopy description of fundus findings UST:
Ophtha Emergencies(3 pts) A002-
(20%) 17-
Quiz (20%) FO01
Attendance (10%)
UST Faculty of Medicine and Surgery
Participation (10%)
TOTAL Department of Ophthalmology
(100%) JUINIOR INTERNSHIP GRADING SHEET

Junior Intern: TIONGSON, Candice Marie Elizabeth Date of Rotation:

APRIL 16-23, 2017

I. MINI REVALIDA
History Taking (5pts)

Eye Exam (5pts)

Discussion (5pts)

Fundoscopy (5pts) 5pts _________

 _______________________
CONSULTANTs
SIGNATURE
Accuracy- Made a concise and accurate (2pts)
history
Completeness- Asked all pertinent (2pts)
II. questions FUNDOSCOPY
Presentation- Presented organized (1pt)
thoughts,
proper language and form

III. EMERGENCIES __________________

IV. OPERA
1stfundoscop 2ndfundoscopy TING
y ROOM
Index finger on dialing knob (1 pt)
Proper hand and eye positioning
(3pts)
Checks for ROR and compares
Mini Revalida (20%)bilaterally (3pts)
Reports (20%)
Fundoscopy description of fundus findings
Ophtha Emergencies(3 pts)
(20%) ROTATION
Quiz (20%) __________________
Attendance (10%)
Participation (10%)
TOTAL
(100%)

UST: A002-17-FO01
UST Faculty of Medicine and Surgery
Department of Ophthalmology
JUINIOR INTERNSHIP GRADING SHEET

Junior Intern: TUMBOCON, Yzabel Nicole Date of Rotation:

APRIL 16-23, 2017

I. MINI REVALIDA
History Taking (5pts)
 Eye Exam (5pts)

Discussion (5pts)

Completeness- Did pertinent tests (2pts)

Accuracy- Made accurate observations (3pt) Fundoscopy
(5pts)
Arrived at a reasonable diagnosis and (2pts)
differentials 5pts
Discussed case with sufficient (3pt) _________
background knowledge
_______________________

1stfundoscop 2ndfundoscopy
y
Index finger on dialing knob (1 pt)
Proper hand and eye positioning
(3pts)
Checks for ROR and compares
Mini Revalida (20%)bilaterally (3pts)
Reports (20%)
Fundoscopy description of fundus findings
Ophtha Emergencies(3 pts)
(20%) CONSULTANTs
Quiz (20%) SIGNATURE
Attendance (10%)
Participation (10%)
TOTAL
(100%)
II. FUNDOSCOPY

III. EMERGENCIES __________________

IV. OPERATING ROOM ROTATION __________________

UST: A002-17-FO01
 UST Faculty of Medicine and Surgery
Department of Ophthalmology
JUINIOR INTERNSHIP GRADING SHEET

Junior Accuracy- Made a concise and accurate (2pts) Intern: TUNGOL,

history Danica Grace
Completeness- Asked all pertinent (2pts) Date
of questions Rotation: APRIL 16-
23, Completeness- Did pertinent tests (2pts) 2017
Presentation- Presented organized (1pt)
Accuracy-
thoughts, Made accurate observations (3pt)
I. MINI REVALIDA
proper language
Arrived and form
at a reasonable diagnosis and (2pts) History
differentials Taking
Discussed case with sufficient (3pt) (5pts)
background knowledge

1stfundoscop 2ndfundoscopy
y
Index finger on dialing knob (1 pt)
Proper hand and eye positioning
(3pts)
Checks for ROR and compares
bilaterally (3pts)
Reports description of fundus findings
(3 pts)

Eye Exam (5pts)

Discussion (5pts)

Fundoscopy (5pts) 5pts _________

_______________________
CONSULTANTs
SIGNATURE

II. FUNDOSCOPY

III. EMERGENCIES __________________

 IV. OPERATING ROOM ROTATION __________________

Accuracy- Made a concise and accurate (2pts)

history
Completeness- Asked all pertinent (2pts)
questions
Completeness- Did pertinent
Presentation- Presented tests
organized (2pts)
(1pt)
Accuracy-
thoughts, Made accurate observations (3pt)
proper language
Arrived and form
at a reasonable diagnosis and (2pts)
UST: A002-17-FO01
UST differentials Faculty of
Discussed case with sufficient (3pt) Medicine and
background knowledge Surgery
Department of Ophthalmology
JUINIOR INTERNSHIP GRADING SHEET

Junior Intern: TURARAY, Nicole Marie Eleanor Date of Rotation:

APRIL 16-23, 2017

I. MINI REVALIDA
History Taking (5pts)
Mini Revalida (20%)
Fundoscopy (20%)
Ophtha Emergencies
(20%)
Quiz (20%)
Attendance (10%)
Eye Exam (5pts)
Participation (10%)
TOTAL
(100%)

Discussion (5pts)

Fundoscopy (5pts) 5pts _________

_______________________
CONSULTANTs
SIGNATURE

II. FUNDOSCOPY
 Accuracy- Made a concise and accurate (2pts)
history
III. Completeness- Asked all pertinent (2pts) EMERGENCIES
questions
Completeness- Did pertinent
Presentation- Presented tests
organized (2pts)
(1pt)
Accuracy- __________________
thoughts, Made accurate observations (3pt)
proper language
Arrived and form
at a reasonable diagnosis and (2pts)
IV. OPERATING ROOM
differentials ROTATION
Discussed case with sufficient (3pt)
background knowledge __________________

1stfundoscop 2ndfundoscopy
y
Index finger on dialing knob (1 pt)
Proper hand and eye positioning
(3pts)
Checks for ROR and compares
Mini Revalida (20%)bilaterally (3pts)
Reports (20%)
Fundoscopy description of fundus findings UST:
Ophtha Emergencies(3 pts) A002-
(20%) 17-
Quiz (20%) FO01
Attendance (10%)
UST Faculty of Medicine and Surgery
Participation (10%)
TOTAL Department of Ophthalmology
(100%) JUINIOR INTERNSHIP GRADING SHEET

Junior Intern: UTANES, Rene Mar Date of Rotation: APRIL

16-23, 2017

I. MINI REVALIDA
History Taking (5pts)

Eye Exam (5pts)

Discussion (5pts)

Fundoscopy (5pts) 5pts _________

 _______________________
CONSULTANTs
SIGNATURE

II. FUNDOSCOPY

III. EMERGENCIES __________________

IV. OPERATING ROOM ROTATION __________________

1stfundoscop 2ndfundoscopy
y
Index finger on dialing knob (1 pt)
Proper hand and eye positioning
(3pts)
Checks for ROR and compares
Mini Revalida (20%)bilaterally (3pts)
Reports (20%)
Fundoscopy description of fundus findings
Ophtha Emergencies(3 pts) UST:
(20%) A002-
Quiz (20%) 17-FO01
Attendance (10%)
Participation (10%)
TOTAL
(100%)