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RURAL MIXED PRACTICE CASE REPORT ACADEMIC BOARD POLICY: ACADEMIC DISHONESTY AND PLAGIARISM COMPLIANCE STATEMENT INDIVIDUAL / COLLABORATIVE WORK I/We certify that: (1) I/We have read and understood the University of Sydney Academic Board Policy: Academic Dishonesty and Plagiarism; (2) I/We understand that failure to comply with the Academic Board Policy: Academic Dishonesty and Plagiarism can lead to the University commencing proceedings against me/us for potential student misconduct under Chapter 8 of the University of Sydney By-Law 1999 (as amended); (3) I/We accept that the Work submitted with this Compliance Statement is the version of the Work that will be assessed. Complete all fields in the following table. Typewritten name(s) in the signature column will be accepted as signature(s) for electronic submissions only. Veterinary Student Intern’s Name: Veterinary Student Intern’s Signature: SID: Date: My Placement ID: Site Name: Rotation: Unit of Study: Placement Start Date: Placement Finish Date: Supervisor’s Name: Supervisor’s Email: Supervisor’s Phone: Unit of Study Coordinator: I agree to this document being made available on the Faculty’s secured Partners in Veterinary Education web site where it maybe accessed by our Partners in Veterinary Education. Yes/No (delete not applicable) 1 Rural Mixed Practice Intern Case Recording Form Date Veterinary Intern’s Name Intern’s Case Number Clinic Case Number Practitioner Patient’s Name Species Breed Sex Age Presenting Complaint History Presentation, progression, and duration of problem Number affected Number at risk Number dead Type of Management system Diet (Composition and recent changes) Vaccination (Product and timing) Worming (Product and timing) Prior and current production Physical findings (highlight abnormalities) Problem List 2 Differential Diagnoses Diagnostic Plan (Actual or Potential - discuss how the diagnostic plan could rule in or out each of the differential diagnoses) Interpretation of Diagnostic Results Prognosis Therapeutic Plan (Discuss the logic of the therapeutic plan relative to the pathophysiology of the disease process) Patient or Herd Outcome (Describe the patients outcome and in the event of a complicated recovery explain what may have contributed to the development of complications) Recommendations Regarding Disease Prevention (Individual and Herd) Summaries costs (account to date, financial restrictions imposed on case management) 3 Rural Mixed Practice Intern Case Recording Form Date Veterinary Intern’s Name Intern’s Case Number Clinic Case Number Practitioner Patient’s Name Species Breed Sex Age Presenting Complaint History Presentation, progression, and duration of problem Number affected Number at risk Number dead Type of Management system Diet (Composition and recent changes) Vaccination (Product and timing) Worming (Product and timing) Prior and current production Physical findings (highlight abnormalities) Problem List 4 Differential Diagnoses Diagnostic Plan (Actual or Potential - discuss how the diagnostic plan could rule in or out each of the differential diagnoses) Interpretation of Diagnostic Results Prognosis Therapeutic Plan (Discuss the logic of the therapeutic plan relative to the pathophysiology of the disease process) Patient or Herd Outcome (Describe the patients outcome and in the event of a complicated recovery explain what may have contributed to the development of complications) Recommendations Regarding Disease Prevention (Individual and Herd) Summaries costs (account to date, financial restrictions imposed on case management) 5 Rural Mixed Practice Intern Case Recording Form Date Veterinary Intern’s Name Intern’s Case Number Clinic Case Number Practitioner Patient’s Name Species Breed Sex Age Presenting Complaint History Presentation, progression, and duration of problem Number affected Number at risk Number dead Type of Management system Diet (Composition and recent changes) Vaccination (Product and timing) Worming (Product and timing) Prior and current production Physical findings (highlight abnormalities) Problem List 6 Differential Diagnoses Diagnostic Plan (Actual or Potential - discuss how the diagnostic plan could rule in or out each of the differential diagnoses) Interpretation of Diagnostic Results Prognosis Therapeutic Plan (Discuss the logic of the therapeutic plan relative to the pathophysiology of the disease process) Patient or Herd Outcome (Describe the patients outcome and in the event of a complicated recovery explain what may have contributed to the development of complications) Recommendations Regarding Disease Prevention (Individual and Herd) Summaries costs (account to date, financial restrictions imposed on case management) 7