1. Rotation Schedule Form
REVISED DECEMBER 2011
Student Name _________________________________________________ Clinical Site __________________________________ Start Date _____________
Enter a checkmark for the corresponding rotation.
Week 1
Week 2
Week 3
Week 4
Hospital
Shift Times 01 02 03 04 05 06 07
Diagnostic
ED / Urgent Care
Fluoro
Ortho
Surgery
Portables
Clinic / Out Patient
Orthopedics
Ambulatory Surgery
Week 5
Week 6
Week 7
Week 8
Hospital
Shift Times 01 02 03 04 05 06 07
Diagnostic
ED / Urgent Care
Fluoro
Ortho
Surgery
Portables
Clinic / Out Patient
Orthopedics
Ambulatory Surgery
Clinical Instructor Signature _________________________________________________
Appendix A: Rotation Schedule Form