Evaluation

Select One:

Mid Rotation Evaluation

Final Evaluation

Student Name:

Clinical Site:

Preceptor:

Clinical Practice Focus at Clinical Site (choose appropriate focus) :

Please rate your student's achievement of the following objectives on a 1 to 5 scale, where 1= directed by preceptor; 3 = requires some preceptor assistance/direction; 5= usually self-directed.

7. Describes etiology, developmental considerations, pathogenesis and clinical manifestations of specific disease processes:

8. Demonstrates knowledge of pathophysiology of acute and chronic diseases commonly encountered in the practice setting:

11.Develops a plan of care with the patient that reflects the patient’s educational needs, lifestyle, culture, and family and community resources:

14. Assesses and manages:

most common acute illnesses, including demonstration of knowledge of pharmacologic interventions as appropriate, for patients across the lifespan according to legal parameters and current standards of care.

15. Assesses and manages:

stable chronic conditions, including demonstration of knowledge of pharmacologic interventions as appropriate, for patients across the lifespan according to legal parameters and current standards of care.

19. Evaluates the effectiveness of the plan of care for the patient, as well as the family and implements changes as appropriate:

Pass/Fail at final evaluation only :

Pass

Fail

I attest to the fact that at final evaluation, I have reviewed the student's electronic clinical assignment folder and have verified that it contains the following:

1- completed Hours Log indicating a minimum of 110 hours
2- completed SELF evaluation by student:

Comments:

Clinical Faculty :

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