Performance Evaluation Sheet

Herzing University - Campus

EXTERNSHIP PRACTICUM CHECK OFF SHEET

Student Name:

Externship Start Date: Externship End Date:

Please answer the Performed question with one of the following;

5 = Strongly Agree 4 = Agree 3 = Neutral (acceptable) 2 = Disagree 1 = Strongly Disagree N/A = Not available at this site

If the student did not perform the skill but was able to observe it, please check the observed box.

If the student did not perform or observe, please indicate why. Ex: we do not perform EKG’s.

1. Adapt to change.

1. Maintain confidentiality at all times.

1. Use appropriate guidelines when releasing records or

1. Project a positive and responsible attitude.

1. Be cognizant of ethical boundaries.

1. Conduct work within scope of education, training, ability

1. Dispose of controlled substances in compliance with government regulations.

1. Follow established policy in initiating or terminating medical treatment.

1. Orient patients to office policies and procedures.

1. Adapt what is said to the recipient’s level of comprehension.

1. Adaptation for individualized needs, Instruct patients with special needs.

1. Teach patients methods of health promotion and disease prevention.

1. Locate resources and information for patients and employers

1. Use proper telephone techniques.

1. Application of electronic technology.

1. Schedule and monitor appointments,

1. Apply computer concepts for office procedures,

1. Schedule inpatient and outpatient admissions.

1. Prepare and maintain medical records.

1. File medical records

1. Establish and maintain a petty cash fun.

1. Perform basic administrative skills.

1. Prepare and maintain records for accounting and banking purposes bank statement.

1. Post entries on a day sheet.

1. Reconcile a bank statement.

1. Prepare a check.

1. Post NSF funds.

1. Process credit balance.

1. Process refunds.

1. Post collection agency payments.

1. Post adjustments.

1. Use manual and computerized bookkeeping systems

1. Manage accounts payable and receivable.

1. Receive, organize, prioritize, and transmit information expediently.

1. Perform billing and collection procedures.

1. Analyze and use current third-party guidelines for reimbursement.

1. Perform diagnostic coding.

1. Complete insurance claim forms.

1. Use physician fee schedule,

1. Implement current procedural terminology and ICD-9 coding.

1. Be courteous and diplomatic.

1. Service as a liaison between the physician and others,

1. Exercise efficient time management.

1. Fundamental writing skills.

1. Operate and maintain facilities and equipment safety.

1. Inventory equipment and supplies,

1. Evaluate and recommend equipment and supplies for practice.

1. Orient and train personnel.

1. Use correct grammar, spelling and formatting techniques in written works.

1. Principles of verbal and nonverbal communication.

1. Use appropriate medical terminology.

1. Perform telephone and in person screening.

1. Take vital signs.

1. Document accurately.

1. Be attentive, Listen, and learn.

1. Interview effectively.

1. Recognize and respond to verbal and nonverbal communication.

1. Interview and take a patient history.

1. Be a “team player”.

1. Exhibit initiative.

1. Be impartial and show empathy when dealing with patients.

1. Recognize emergencies.

1. Perform first aid and CPR.

1. Perform selected tests that assist with diagnosis and treatment.

1. Instruct patient in the collection of a specimen.

1. Prepare patients for procedures.

1. Wrap items for autoclaving,

1. Perform sterilization techniques.

1. Instruct patient in the collection of fecal specimen.

1. Instruct patient in the collection of a clean catch midstream urine specimen,

1. Use quality control, perform urinalysis

1. Perform electrocardiograms.

1. Perform respiratory testing.

1. Prepare and administer medications as directed by physicians (oral).

1. Prepare and administer medications as directed by physicians (parenteral).

1. Apply principles of aseptic technique and infection control.

1. Assist physician with examinations and treatments.

1. Perform selected tests that assist with diagnosis and treatment.

1. Prepare patients for procedures.

1. Maintain medication records.

1. Screen and follow up patient test results.

1. Perform risk management procedures.

1. Dispose of bio-hazardous materials.

1. Practice standard precaution.

1. Perform venipuncture.

1. Document accurately.

1. Collect and process specimens.

1. Perform capillary puncture.

1. Perform chemistry testing.

1. Use quality control.

1. Perform microbiology testing.

1. Perform hematology.

1. Perform immunology testing.

1. Determine needs for documentation and reporting.

Comments: ______

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Externship supervisor comments/suggestions for the Herzing University medical assisting program:

1. What do you perceive is/are the strength(s) of Herzing University’s medical assisting program?

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1. What do you perceive are areas where Herzing University’s medical assisting program can improve?

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1. Please evaluate the responsiveness and support provided by the designated school representative who remained in contact (or visited as applicable) throughout the duration of the externship.

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1. Additional comments and/or suggestions:

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Student signature: ______Date: ______

Externship supervisor signature: ______Date: ______

SICCED03161814.HU.Externship Survey Questionsv2