Case Based Discussion (CBD)
CASE NOTES SUMMARY
Candidate name: ______________________________________________________________
A total of 12 cases are required to be submitted, of which 6 cases will are chosen for the assessment. All 12 case
notes are required to be uploaded by the due date in the semester you are enrolled in. All candidates submitting
cases by the due date are guaranteed that the assessors will be appointed to enable to the assessment to be
completed within the enrolment semester.
2017 semester due dates for case submissions:
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First semester 2017A - by the 17th March 2017
Second semester 2017B – by the 21st July
Candidate declaration
I hereby confirm that:
 I have read and understood the process outlined in chapter six of the Fellowship Assessment Handbook
for uploading clinical notes to ensure that the confidentiality and privacy of patient clinical details are
rigorously maintained
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the attached documents are a true record of my clinical notes recorded at the time of the consult and
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I have sought permission from my employer/owner of the facility to provide these notes as part of my Case
Based Discussion assessment with the Australian College of Rural & Remote Medicine.
Signed: _________________________________________
Date: ____________________________
Employer declaration
I declare I am aware the above named candidate is providing the attached clinical notes for use in their Case
Based Discussion Assessment with the Australian College of Rural & Remote Medicine.
Name: _________________________________________
Position: ___________________________
Signed: ________________________________________
Date: ______________________________
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CBD Case Note Summary Form 2017
Cases note details
Please complete the case details required for each case note submitted. Note there can be more than one
curriculum statement per case. All 12 cases must be provided up front.
Case
number
Gender
Patient
Age
Type of health
service
Curriculum statement
Reason for consult:
Abbreviations
Type of Health Service
GP: General Practice
AMS: Aboriginal Medical Service
EM: Emergency Department
RH: Rural Hospital
Other: please describe
Curriculum Statements
ATSIH - Aboriginal and Torres Strait Islander Health
AIM - Adult Internal Medicine
AGED CARE - Aged Care
Anaes – Anaesthetics
CAH - Child and Adolescent Health
DERM - Dermatology
O & WH - Obstetrics and Women’s Health
ORAL - Oral Health
OPTHA - Ophthalmology
PALMED - Palliative Medicine
*MH - Mental Health
MSK - Musculoskeletal Medicine
RAD – Radiology
RHM - Rehabilitation Medicine
SURG - Surgery
*Candidates are required to cover at least one mental health case
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CBD Case Note Summary Form 2017
Checklist for candidates__________________________________________________________________
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read the CBD Process, Rules and Regulations contained in this handbook
return signed Code of Conduct if not completed previously
obtain permission gained from employer to copy case notes
source a suitable room and assessment invigilator
complete the community profile
ensure case notes meet the requirements as stated in the handbook including at least one mental health case
complete the CBD case notes summary form with the curriculum statements(s) for each case covered and the
number awarded to each case
number case notes according to the summary form
strictly follow the de-identification rules for submitting case notes
upload all twelve case notes up front by due date
notify the College when the case notes are uploaded.
Case note de-identification procedure________________________________________________________
The following processes must be followed to ensure that the confidentiality and privacy of patient clinical details are
rigorously maintained. Any unauthorised deviation from these processes will result in a candidate failing the CBD
for breach of assessment process.
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From the computerised medical record system, print off the relevant clinical data for the cases chosen for
consideration for the CBD session. Ensure that key patient identifiers – name and address – are deleted. We
strongly recommend the case notes be de-identified with whiteout not black felt pen. Black felt pen does not
sufficiently de-identify records. Do not delete gender, DOB or date of the consultation.
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Scan the de-identified notes and save them as a Portable Document Format (PDF) file. A 5mb limit is the
maximum file size that can be uploaded.
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Uploaded into the ‘My Documents’ tool via the ‘My College’ dashboard, accessible from the College website.
Please select the document type ‘CBD Case’. Do not email, post or fax without contacting the College.
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If it’s not possible to scan and upload cases, contact the College immediately to discuss other options.
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CBD Case Note Summary Form 2017
Registrar Case Based Discussion Community Profile Form
Please provide a brief community profile to describe your locality
Candidate Name:

Emergency transport:

Other:
Yes
No
Your Role:
Community demographics and geography (please do not indicate the town
where this profile is located):
Distance to regional hospital:
Distance to tertiary hospital:
Health services in community:
Add further details you think are relevant to your locality:

General practice/s:
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Local hospital:
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Other health services, please describe:
Yes
Yes
No
No
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CBD Case Note Summary Form 2017