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Please check the appropriate rating space for each item listed below, indicating the quality level you have observed in this
student. Base your judgments on definite evidence and omit any items for which you have too little information.
1 2 3 4 5 Comments:
(Poor) (Great)
Demonstrates professional behavior
Maturity ___ ___ ___ ___ ___ ____________________________
Knowledge Needed for Experience ___ ___ ___ ___ ___ ____________________________
Excelled in online curriculum and quickly learned the
EMR and providers preferences
Ability to Deal with Public ___ ___ ___ ___ ___ ____________________________
Demonstrated great rapport with the patients during encounters.
This directed study evaluation is to be completed by the Facility Supervisor near the completion of the student's work
assignment period. Use of this evaluation in grading the student is left to the discretion of the Instructor. Please review this
information with the student.
____________________________________________________ 4/24/2019
Date: ______________________________
Practicum Supervisor (Signature)