iMOKO Digital Health Aide

Assessment Log

Applicant Name______

Instructions:Complete a new Assessment Log for ten (10) initial clinical health assessments performed by me in my role as an iMOKO digital health aide.

Assessment Log: Is a record of the initial clinical health assessment undertaken by you in your role as an iMOKO digital health aide and diagnosis and treatment prescribed based on my clinical findings report. This must be filled in electronically in the square provided.

Patient # 1

Task 1.3 and Task 2.1
Gender of Child / Whānau
Consent / Age of Child / Weight
(kgs) / Temp
(C) / The Presenting Condition
Yes/No
Issues, concerns background information about the patient or siblings/whanau.
Diagnosis from the Clinician, based on your clinical findings.
Medication/s prescribed by the Clinician.
Description of treatment plan/follow-up as required by the clinician.

This information is verified below by my Supervisor as a true and correct report of this patient in response to their health assessment.

Name: Date: Signature:

Patient # 2

Task 1.3 and Task 2.1
Gender of Child / Whānau
Consent / Age of Child / Weight
(kgs) / Temp
(C) / The Presenting Condition
Yes/No
Issues, concerns background information about the patient or siblings/whanau.
Diagnosis from the Clinician, based on your clinical findings.
Medication/s prescribed by the Clinician.
Description of treatment plan/follow-up as required by the clinician.

This information is verified below by my Supervisor as a true and correct report of this patient in response to their health assessment.

Name: Date: Signature:

Patient # 3

Task 1.3 and Task 2.1
Gender of Child / Whānau
Consent / Age of Child / Weight
(kgs) / Temp
(C) / The Presenting Condition
Yes/No
Issues, concerns background information about the patient or siblings/whanau.
Diagnosis from the Clinician, based on your clinical findings.
Medication/s prescribed by the Clinician.
Description of treatment plan/follow-up as required by the clinician.

This information is verified below by my Supervisor as a true and correct report of this patient in response to their health assessment.

Name: Date: Signature:

Patient # 4

Task 1.3 and Task 2.1
Gender of Child / Whānau
Consent / Age of Child / Weight
(kgs) / Temp
(C) / The Presenting Condition
Yes/No
Issues, concerns background information about the patient or siblings/whanau.
Diagnosis from the Clinician, based on your clinical findings.
Medication/s prescribed by the Clinician.
Description of treatment plan/follow-up as required by the clinician.

This information is verified below by my Supervisor as a true and correct report of this patient in response to their health assessment.

Name: Date: Signature:

Patient # 5

Task 1.3 and Task 2.1
Gender of Child / Whānau
Consent / Age of Child / Weight
(kgs) / Temp
(C) / The Presenting Condition
Yes/No
Issues, concerns background information about the patient or siblings/whanau.
Diagnosis from the Clinician, based on your clinical findings.
Medication/s prescribed by the Clinician.
Description of treatment plan/follow-up as required by the clinician.

This information is verified below by my Supervisor as a true and correct report of this patient in response to their health assessment.

Name: Date: Signature:

Patient # 6

Task 1.3 and Task 2.1
Gender of Child / Whānau
Consent / Age of Child / Weight
(kgs) / Temp
(C) / The Presenting Condition
Yes/No
Issues, concerns background information about the patient or siblings/whanau.
Diagnosis from the Clinician, based on your clinical findings.
Medication/s prescribed by the Clinician.
Description of treatment plan/follow-up as required by the clinician.

This information is verified below by my Supervisor as a true and correct report of this patient in response to their health assessment.

Name: Date: Signature:

Patient # 7

Task 1.3 and Task 2.1
Gender of Child / Whānau
Consent / Age of Child / Weight
(kgs) / Temp
(C) / The Presenting Condition
Yes/No
Issues, concerns background information about the patient or siblings/whanau.
Diagnosis from the Clinician, based on your clinical findings.
Medication/s prescribed by the Clinician.
Description of treatment plan/follow-up as required by the clinician.

This information is verified below by my Supervisor as a true and correct report of this patient in response to their health assessment.

Name: Date: Signature:

Patient # 8

Task 1.3 and Task 2.1
Gender of Child / Whānau
Consent / Age of Child / Weight
(kgs) / Temp
(C) / The Presenting Condition
Yes/No
Issues, concerns background information about the patient or siblings/whanau.
Diagnosis from the Clinician, based on your clinical findings.
Medication/s prescribed by the Clinician.
Description of treatment plan/follow-up as required by the clinician.

This information is verified below by my Supervisor as a true and correct report of this patient in response to their health assessment.

Name: Date: Signature:

Patient # 9

Task 1.3 and Task 2.1
Gender of Child / Whānau
Consent / Age of Child / Weight
(kgs) / Temp
(C) / The Presenting Condition
Yes/No
Issues, concerns background information about the patient or siblings/whanau.
Diagnosis from the Clinician, based on your clinical findings.
Medication/s prescribed by the Clinician.
Description of treatment plan/follow-up as required by the clinician.

This information is verified below by my Supervisor as a true and correct report of this patient in response to their health assessment.

Name: Date: Signature:

Patient # 10

Task 1.3 and Task 2.1
Gender of Child / Whānau
Consent / Age of Child / Weight
(kgs) / Temp
(C) / The Presenting Condition
Yes/No
Issues, concerns background information about the patient or siblings/whanau.
Diagnosis from the Clinician, based on your clinical findings.
Medication/s prescribed by the Clinician.
Description of treatment plan/follow-up as required by the clinician.

This information is verified below by my Supervisor as a true and correct report of this patient in response to their health assessment.

Name: Date: Signature: