Genetic Counseling Rotation Course Case logs (01:447:488)
Student name:
Case log number (i.e., 1-10): 1
Counseling Session Date(s):
Supervising Genetic Counselor:
Patient’s initials or Case number:
Service Type: ____ Cancer ___ Prenatal ___ Pre-Pregnancy ___ Pediatric ___ Adult Genetics
Management/Counseling Roles Observed (mark “X” to all that apply):
Case preparation / Contracting / Eliciting of medical historyDiscussion of testing options/ results / Risk assessment / Resource identification and referral
Psychosocial assessment / Follow-up / Discussion of diagnosis and natural history
Inheritance/risk counseling / Pedigree / Psychosocial support/counseling
Reasons for referral & medical history (include age, gender and ethnicity):
Pregnancy History (if applicable):
Family history information:
Testing (include prior testing, tests arranged and any results including after counseling session):
About the diagnosis (include inheritance pattern, recurrence risk, prognosis, and known genetic mutations):
Counseling session and psychosocial issues (describe the psychosocial issues in session):
Discuss if you felt the patient was engaged, asked appropriate questions and understood the information:
What new information did you learn from this session? Discuss some unique aspects of this case (medical, psychosocial, emotional, etc).
Genetic Counseling Rotation Course Case logs (01:447:488)
Student name:
Case log number (i.e., 1-10): 2
Counseling Session Date(s):
Supervising Genetic Counselor:
Patient’s initials or Case number:
Service Type: ____ Cancer ___ Prenatal ___ Pre-Pregnancy ___ Pediatric ___ Adult Genetics
Management/Counseling Roles Observed (mark “X” to all that apply):
Case preparation / Contracting / Eliciting of medical historyDiscussion of testing options/ results / Risk assessment / Resource identification and referral
Psychosocial assessment / Follow-up / Discussion of diagnosis and natural history
Inheritance/risk counseling / Pedigree / Psychosocial support/counseling
Reasons for referral & medical history (include age, gender and ethnicity):
Pregnancy History (if applicable):
Family history information:
Testing (include prior testing, tests arranged and results):
About the diagnosis (include inheritance pattern, recurrence risk, prognosis, and known genetic mutations):
Counseling session and psychosocial issues (describe the psychosocial issues in session):
Discuss if you felt the patient was engaged, asked appropriate questions and understood the information:
What new information did you learn from this session? Discuss some unique aspects of this case (medical, psychosocial, emotional, etc).
Genetic Counseling Rotation Course Case logs (01:447:488)
Student name:
Case log number (i.e., 1-10): 3
Counseling Session Date(s):
Supervising Genetic Counselor:
Patient’s initials or Case number:
Service Type: ____ Cancer ___ Prenatal ___ Pre-Pregnancy ___ Pediatric ___ Adult Genetics
Management/Counseling Roles Observed (mark “X” to all that apply):
Case preparation / Contracting / Eliciting of medical historyDiscussion of testing options/ results / Risk assessment / Resource identification and referral
Psychosocial assessment / Follow-up / Discussion of diagnosis and natural history
Inheritance/risk counseling / Pedigree / Psychosocial support/counseling
Reasons for referral & medical history (include age, gender and ethnicity):
Pregnancy History (if applicable):
Family history information:
Testing (include prior testing, tests arranged and results):
About the diagnosis (include inheritance pattern, recurrence risk, prognosis, and known genetic mutations):
Counseling session and psychosocial issues (describe the psychosocial issues in session):
Discuss if you felt the patient was engaged, asked appropriate questions and understood the information:
What new information did you learn from this session? Discuss some unique aspects of this case (medical, psychosocial, emotional, etc).
Genetic Counseling Rotation Course Case logs (01:447:488)
Student name:
Case log number (i.e., 1-10): 4
Counseling Session Date(s):
Supervising Genetic Counselor:
Patient’s initials or Case number:
Service Type: ____ Cancer ___ Prenatal ___ Pre-Pregnancy ___ Pediatric ___ Adult Genetics
Management/Counseling Roles Observed (mark “X” to all that apply):
Case preparation / Contracting / Eliciting of medical historyDiscussion of testing options/ results / Risk assessment / Resource identification and referral
Psychosocial assessment / Follow-up / Discussion of diagnosis and natural history
Inheritance/risk counseling / Pedigree / Psychosocial support/counseling
Reasons for referral & medical history (include age, gender and ethnicity):
Pregnancy History (if applicable):
Family history information:
Testing (include prior testing, tests arranged and results):
About the diagnosis (include inheritance pattern, recurrence risk, prognosis, and known genetic mutations):
Counseling session and psychosocial issues (describe the psychosocial issues in session):
Discuss if you felt the patient was engaged, asked appropriate questions and understood the information:
What new information did you learn from this session? Discuss some unique aspects of this case (medical, psychosocial, emotional, etc).
Genetic Counseling Rotation Course Case logs (01:447:488)
Student name:
Case log number (i.e., 1-10): 5
Counseling Session Date(s):
Supervising Genetic Counselor:
Patient’s initials or Case number:
Service Type: ____ Cancer ___ Prenatal ___ Pre-Pregnancy ___ Pediatric ___ Adult Genetics
Management/Counseling Roles Observed (mark “X” to all that apply):
Case preparation / Contracting / Eliciting of medical historyDiscussion of testing options/ results / Risk assessment / Resource identification and referral
Psychosocial assessment / Follow-up / Discussion of diagnosis and natural history
Inheritance/risk counseling / Pedigree / Psychosocial support/counseling
Reasons for referral & medical history (include age, gender and ethnicity):
Pregnancy History (if applicable):
Family history information:
Testing (include prior testing, tests arranged and results):
About the diagnosis (include inheritance pattern, recurrence risk, prognosis, and known genetic mutations):
Counseling session and psychosocial issues (describe the psychosocial issues in session):
Discuss if you felt the patient was engaged, asked appropriate questions and understood the information:
What new information did you learn from this session? Discuss some unique aspects of this case (medical, psychosocial, emotional, etc).
Genetic Counseling Rotation Course Case logs (01:447:488)
Student name:
Case log number (i.e., 1-10): 6
Counseling Session Date(s):
Supervising Genetic Counselor:
Patient’s initials or Case number:
Service Type: ____ Cancer ___ Prenatal ___ Pre-Pregnancy ___ Pediatric ___ Adult Genetics
Management/Counseling Roles Observed (mark “X” to all that apply):
Case preparation / Contracting / Eliciting of medical historyDiscussion of testing options/ results / Risk assessment / Resource identification and referral
Psychosocial assessment / Follow-up / Discussion of diagnosis and natural history
Inheritance/risk counseling / Pedigree / Psychosocial support/counseling
Reasons for referral & medical history (include age, gender and ethnicity):
Pregnancy History (if applicable):
Family history information:
Testing (include prior testing, tests arranged and results):
About the diagnosis (include inheritance pattern, recurrence risk, prognosis, and known genetic mutations):
Counseling session and psychosocial issues (describe the psychosocial issues in session):
Discuss if you felt the patient was engaged, asked appropriate questions and understood the information:
What new information did you learn from this session? Discuss some unique aspects of this case (medical, psychosocial, emotional, etc).
Genetic Counseling Rotation Course Case logs (01:447:488)
Student name:
Case log number (i.e., 1-10): 7
Counseling Session Date(s):
Supervising Genetic Counselor:
Patient’s initials or Case number:
Service Type: ____ Cancer ___ Prenatal ___ Pre-Pregnancy ___ Pediatric ___ Adult Genetics
Management/Counseling Roles Observed (mark “X” to all that apply):
Case preparation / Contracting / Eliciting of medical historyDiscussion of testing options/ results / Risk assessment / Resource identification and referral
Psychosocial assessment / Follow-up / Discussion of diagnosis and natural history
Inheritance/risk counseling / Pedigree / Psychosocial support/counseling
Reasons for referral & medical history (include age, gender and ethnicity):
Pregnancy History (if applicable):
Family history information:
Testing (include prior testing, tests arranged and results):
About the diagnosis (include inheritance pattern, recurrence risk, prognosis, and known genetic mutations):
Counseling session and psychosocial issues (describe the psychosocial issues in session):
Discuss if you felt the patient was engaged, asked appropriate questions and understood the information:
What new information did you learn from this session? Discuss some unique aspects of this case (medical, psychosocial, emotional, etc).
Genetic Counseling Rotation Course Case logs (01:447:488)
Student name:
Case log number (i.e., 1-10): 8
Counseling Session Date(s):
Supervising Genetic Counselor:
Patient’s initials or Case number:
Service Type: ____ Cancer ___ Prenatal ___ Pre-Pregnancy ___ Pediatric ___ Adult Genetics
Management/Counseling Roles Observed (mark “X” to all that apply):
Case preparation / Contracting / Eliciting of medical historyDiscussion of testing options/ results / Risk assessment / Resource identification and referral
Psychosocial assessment / Follow-up / Discussion of diagnosis and natural history
Inheritance/risk counseling / Pedigree / Psychosocial support/counseling
Reasons for referral & medical history (include age, gender and ethnicity):
Pregnancy History (if applicable):
Family history information:
Testing (include prior testing, tests arranged and results):
About the diagnosis (include inheritance pattern, recurrence risk, prognosis, and known genetic mutations):
Counseling session and psychosocial issues (describe the psychosocial issues in session):
Discuss if you felt the patient was engaged, asked appropriate questions and understood the information:
What new information did you learn from this session? Discuss some unique aspects of this case (medical, psychosocial, emotional, etc).
Genetic Counseling Rotation Course Case logs (01:447:488)
Student name:
Case log number (i.e., 1-10): 9
Counseling Session Date(s):
Supervising Genetic Counselor:
Patient’s initials or Case number:
Service Type: ____ Cancer ___ Prenatal ___ Pre-Pregnancy ___ Pediatric ___ Adult Genetics
Management/Counseling Roles Observed (mark “X” to all that apply):
Case preparation / Contracting / Eliciting of medical historyDiscussion of testing options/ results / Risk assessment / Resource identification and referral
Psychosocial assessment / Follow-up / Discussion of diagnosis and natural history
Inheritance/risk counseling / Pedigree / Psychosocial support/counseling
Reasons for referral & medical history (include age, gender and ethnicity):
Pregnancy History (if applicable):
Family history information:
Testing (include prior testing, tests arranged and results):
About the diagnosis (include inheritance pattern, recurrence risk, prognosis, and known genetic mutations):
Counseling session and psychosocial issues (describe the psychosocial issues in session):
Discuss if you felt the patient was engaged, asked appropriate questions and understood the information:
What new information did you learn from this session? Discuss some unique aspects of this case (medical, psychosocial, emotional, etc).
Genetic Counseling Rotation Course Case logs (01:447:488)
Student name:
Case log number (i.e., 1-10): 10
Counseling Session Date(s):
Supervising Genetic Counselor:
Patient’s initials or Case number:
Service Type: ____ Cancer ___ Prenatal ___ Pre-Pregnancy ___ Pediatric ___ Adult Genetics
Management/Counseling Roles Observed (mark “X” to all that apply):
Case preparation / Contracting / Eliciting of medical historyDiscussion of testing options/ results / Risk assessment / Resource identification and referral
Psychosocial assessment / Follow-up / Discussion of diagnosis and natural history
Inheritance/risk counseling / Pedigree / Psychosocial support/counseling
Reasons for referral & medical history (include age, gender and ethnicity):
Pregnancy History (if applicable):
Family history information:
Testing (include prior testing, tests arranged and results):
About the diagnosis (include inheritance pattern, recurrence risk, prognosis, and known genetic mutations):
Counseling session and psychosocial issues (describe the psychosocial issues in session):
Discuss if you felt the patient was engaged, asked appropriate questions and understood the information:
What new information did you learn from this session? Discuss some unique aspects of this case (medical, psychosocial, emotional, etc).
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