During the 904 Rotation, students will work with a physician in a Rural or Underserved Outpatient Primary Care clinic setting in the United States. There are three realms for the students to encompass on this mandatory fourth-year rotation. First, under the tutelage of the preceptor, the student will gain further clinical exposure to and medical management experience of patients with both acute and chronic conditions in a rural or underserved outpatient setting. A second, but major focus, is understanding how barriers impede the physician’s ability to manage the patients’ care – appreciating how many barriers exist which impact patients’ health, their lives, and ability to acquire healthcare. This rotation revisits the Social Determinants of Health taught in the first year of medical school and challenges the students to apply this knowledge in clinical settings as they seek resources to overcome the barriers. While researching for these solutions, students will have opportunities to be interactive with other office personnel and professionals. Working with clinic patients, the student will focus on the patients’ barriers to healthcare, identify applicable ICD 10 Z codes, search for appropriate solutions, and then discuss the resolution, documenting these reports using the case template. The third focus of the rotation directs the student to perform osteopathic structural evaluations on a select number of patients, identify their medical diagnoses with their correct ICD 10 codes, correlate with Chapman’s viscero-somatic Reflexes, and document the findings on the OPP log template.