CLRC Case Content Change Request Form

Requestor Contact Information
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When will this case be used next? If there is not a date set or you do not know, please leave this blank. When will this case be used next? If there is not a date set or you do not know, please leave this blank. / MM / DD YYYY
Case Information
Please select which customer this case is used for: *

Please select which customer this case is used for: College of Medicine (COM) College of Nursing (CON) Inter-professional Education (IPE) College of Pharmacy (COP) School of Public Health (SPH) KSTAR Physician KSTAR Nursing Other Other
Which COM Course is this case used for?

Which COM Course is this case used for? Practice of Medicine (Formerly HEAL/ICS/M1) Preceptorship (Formerly M2) Family Medicine (M3) Internal Medicine (M3) OB/GYN (M3) Pediatrics (M3) Psychiatry (M3) Surgery (M3)
Please select the PoM case in question by last name

Please select the PoM case in question by last name Abbott Jones Knight Roberts Wickson Other (only if not listed) Other (only if not listed)
Please select the Preceptorship case in question by last name

Please select the Preceptorship case in question by last name Bagwell Barnett Bartek Bean Burkett Connor Crosby Deere Dowling Gibbs Gilman Houston Howard Johnson Jolly Juergens Martinez Padgett Robinson Simms Smith Sodek Stepford Whiteside Williams Other (only if not listed) Other (only if not listed)
Please select the Family Medicine case in question by last name

Please select the Family Medicine case in question by last name Armstrong Bradley Brown Gorman Grimes Hamilton Jacobs Jones Landon McFly Richards Sage Smith Other (only if not listed) Other (only if not listed)
Please select the Internal Medicine case in question by last name

Please select the Internal Medicine case in question by last name Davenport Heard Hearne Hearst Jackson Jacobs Jeffries Jernigan Johnson Larson Martinez Miller Orsak Parker Pickett Proctor Steinman Thornton Other (only if not listed) Other (only if not listed)
Please select the OB/GYN case in question by last name

Please select the OB/GYN case in question by last name Adams Anderson Gonzales Green Hanes Noonan Smith Summer Other (only if not listed) Other (only if not listed)
Please select the Pediatrics case in question by last name

Please select the Pediatrics case in question by last name Brown Hobbs Kay Miller Physical Exam Skills Simon Sisk Smith Williams Other (only if not listed) Other (only if not listed)
Please select the Psychiatry case in question by last name

Please select the Psychiatry case in question by last name Brandon Clark (F) Clark (M) Cooper Eldridge Faulkner Forrest Hare Johnson Kennebrew Kramer MacDonald Madera O'Brian Robertson Wells Other (only if not listed) Other (only if not listed)
Please select the Surgery case in question by last name

Please select the Surgery case in question by last name Chadwell Hargrove Stark Stewart Williams Other (only if not listed) Other (only if not listed)
Which CON Course is this case used for?

Which CON Course is this case used for? Fundamentals (313) Assessment (314) Adult Health I (320) OB (323) Pediatrics (413) Adult Health II (420) Advanced Nursing Practice (MSN/FNP)
Please select the CON Fundamentals case in question by last name

Please select the CON Fundamentals case in question by last name Allen Bley James Mini Mega (Multiple) Reyes Other (only if not listed) Other (only if not listed)
Please select the CON Adult Health I case in question by last name

Please select the CON Adult Health I case in question by last name James Ocampo, D Ocampo, L Reyes Ross Other (only if not listed) Other (only if not listed)
Please select the CON OB case in question by last name

Please select the CON OB case in question by last name Module A (No last name) Wiley Wilson Other (only if not listed) Other (only if not listed)
Please select the CON Adult Health II case in question by last name

Please select the CON Adult Health II case in question by last name Ocampo (2 different cases; please indicate which when requesting changes) Martin Other (only if not listed) Other (only if not listed)
Please select the IPE case in question by last name

Please select the IPE case in question by last name Keaton Mosier Ramirez Smith Other (only if not listed) Other (only if not listed)
Please select the Advanced Nursing Practice case in question by last name or type from the list below

Please select the Advanced Nursing Practice case in question by last name or type from the list below 553 Assessment (Multiple) 553 Final OSCE 523 Adolescent (no last name) 523 Brown 523 Collier 523 Grimes 523 Hendricks 523 Jones 523 Lackey 523 O'Riley 523 Simms 523 Simon 523 Smith 523 Smith 523 Snider 523 Walters 523 Williams 525 Brown 525 Grimes 525 Huntsville 525 Johnson 525 Morgan 525 Sims 525 Smith Other (only if not listed) Other (only if not listed)

523 occurs in the Fall semester only
525 occurs in the Summer semester only
Please select the KSTAR Physician case in question by last name or type from the list below

Please select the KSTAR Physician case in question by last name or type from the list below Adolescent (no last name) Andersen Anderson Anderson, S Barefoot Billingsley (F) Billingsley (M) Bolling Brandon Campos Dawson Demarco Ferguson Finkley Gardner Gonzales Graves Hanes Harris Holmes Howard Jefferson Johnson Jones Jones (PEDS) Lackey Langdon Littlefield Manchelli Mancuso Meyers Michaels Mumford Nesler Noonan Patterson Prolowski Richards Rivera Russell Smith Smith, I Soros Stevenson Stewart Stone Sweeney Sweeney Williams Winlow Other (only if not listed) Other (only if not listed)

523 occurs in the Fall semester only
525 occurs in the Summer semester only
Please select the KSTAR Nursing case in question by last name from the list below

Please select the KSTAR Nursing case in question by last name from the list below Harris Jonas Jonas, G Lawson Miller Miller (PEDS) Monroe Odom Patel Richards Roberts Sheldon (PEDS) Sheldon, J Wilder Wonders Other (only if not listed) Other (only if not listed)

523 occurs in the Fall semester only
525 occurs in the Summer semester only
Case Change Information

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CLRC Case Content Change Request Form

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