1:

Home Visit Report (Suggested Form)

Name & St Nr Student 1 :
Student 2:
Student 3 :
Name of Patient
Patient Address
Patient Contact Mobile: Home Phone:
Name of Family Physician
Additional nformation
A. Introduction
Write in brief what you think the importance of doing Home Visit in order to achieve all
Block 1.6 competences. (max 2 paragraphs
B. Learning Objectives
Write learning ob!ectives you would achieve during "linical #ttachment to $amily %hysician
2:
. Learning !rocess
Write in brief how you did &ome 'isit to patient and background why &ome 'isit is
necessary to be done for the patient and their family (max ( paragraphs
". Lessons Learnt and !ossib#e !reventive Action
Write in brief what lessons you have learnt during &ome 'isit) such as* certain risk factors
related to the family and environment+ and what preventive action should be taken.
3: