1. CLINICAL EXAM & REPEAT LOG
REVISED JULY 2011
Student Name _______________________________________________________ Clinical Site ___________________________________________
Exam Performed
Reason for Repeat (Enter Letter or Appropriate Reason)
Registered Technologist (Initial and check appropriate Category)
Date
MR Number
Exam
Image Repeated
P = Positioning,
T = Technique,
C = Collimation
E = Equipment
Initials
Observed
Assisted
Performed
Appendix G: Clinical Exam and Repeat Log

2. Clinical Director Signature
Student Acknowledgment of Repeat Exam Supervision and Use of the Clinical Exam/Repeat Log
I,____________ ________, acknowledge that I have received and fully understand the policies regarding supervision during repeat examinations and use of the Clinical Exam and Repeat Log. I understand and accept that a registered technologist must initial every exam and that repeat examinations require the direct supervision (physical presence) of a registered technologist. I am required to upload the Clinical Exam/Repeat Log and Clinical Time Sheet to my extern course every week that I have a clinical assignment .
Steve Forshier
Clinical Director Signature
Student Signature
Date
Appendix G: Clinical Exam and Repeat Log