T07 Evidence and reflection record — Blank form
2026 digital edition · Dr Naeem Aziz DGM FRCP · 1 min read
Print this blank worksheet and complete it privately. Responses are not collected by the website. Do not include identifiable patient information. This is a planning aid, not an official application form.
Blank reusable form
Read with chapter 11 and 16
Record learning from real work with minimal identifying detail. Keep clinical records in their proper systems; this is a separate educational record.
Identifier and context
Give a portfolio identifier, broad period and sufficient non-identifying context.
Claim and your contribution
Explain what you did, what others did and the capability you are illustrating.
Reasoning and action
Describe the important decisions and why they were made.
Result and limits
State what is known, what was not measured and what cannot be inferred.
Feedback or verification
Record who can verify which aspect and the basis of their knowledge.
Reflection and next action
Explain what you learned, changed or need to examine further.
Mapping and handling
Identify relevant framework references, authorised storage and disclosure checks.