TCC Student PPE Evaluation Form (Facility to Complete)
Please complete this evaluation form reviewing the student’s skill level for each of the items indicated below. Please refer to the HIM grade scale in the PPE Supervisor Handbook (
http://goo.gl/D2HgOq
) when grading the student. This evaluation serves as the basis for the final grade the student receives in the course.
If you are comfortable, please complete the assessment with the student. We find it is important for the student to receive feedback from the Site Supervisor that monitored the student.
Please complete this as soon as possible. The HIT Program Chair, Jonathan Eastabrooks, will be notified automatically upon completion. If you have any questions, feel free to contact Jonathan at:
(phone) 253.566.5228
(email)
jeastabrooks@tacomacc.edu
* Required
Email address
*
Your email
What is your name and job title?
*
Your answer
What facility do you work at?
*
Your answer
What student are you evaluating?
*
Your answer
Is the student in attendance during the completion of this evaluation?
*
Yes
No
Please complete the items below:
1) Overall grade
*
Choose
100% (A)
92% (A)
91% (B)
88% (B)
83% (B)
82% (C)
80% (C)
76% (C)
75% (D)
65% (D)
64% or below (E)
2) Attendance
*
Student completed 4080 hours of PPE, reported to the department on time each day, and returned from breaks/lunch on time.
Choose
100% (A)
92% (A)
91% (B)
88% (B)
83% (B)
82% (C)
80% (C)
76% (C)
75% (D)
65% (D)
64% or below (E)
Comments
*
Why did you grade the student the way you did for attendance?
Your answer
3) Professionalism
*
Student dressed appropriately, was respectful of colleagues/supervisors, displayed energy and motivation in starting/completing tasks, and functioned in a systematic and logical fashion.
Choose
100% (A)
92% (A)
91% (B)
88% (B)
83% (B)
82% (C)
80% (C)
76% (C)
75% (D)
65% (D)
64% or below (E)
Comments
*
Why did you grade the student the way you did for professionalism?
Your answer
4) Communication
*
Student asked appropriate questions, displayed interest in all tasks assigned, and communicated appropriately with employees, medical staff, and other staff.
Choose
100% (A)
92% (A)
91% (B)
88% (B)
83% (B)
82% (C)
80% (C)
76% (C)
75% (D)
65% (D)
64% or below (E)
Comments
*
Why did you grade the student the way you did for communication?
Your answer
5) Supervision
*
Student was receptive to supervision and accepted constructive criticism with respect.
Choose
100% (A)
92% (A)
91% (B)
88% (B)
83% (B)
82% (C)
80% (C)
76% (C)
75% (D)
65% (D)
64% or below (E)
Comments
*
Why did you grade the student the way you did for supervision?
Your answer
6) Competency 1
*
Student demonstrated ability to understand and complete objectives regarding HIM and facility functions
Choose
100% (A)
92% (A)
91% (B)
88% (B)
83% (B)
82% (C)
80% (C)
76% (C)
75% (D)
65% (D)
64% or below (E)
Comments
*
Why did you grade the student the way you did for competency 1?
Your answer
7) Competency 2
*
Student demonstrated ability to understand and complete objectives regarding the medical record.
Choose
100% (A)
92% (A)
91% (B)
88% (B)
83% (B)
82% (C)
80% (C)
76% (C)
75% (D)
65% (D)
64% or below (E)
Comments
*
Why did you grade the student the way you did for competency 2?
Your answer
8) Competency 3
*
Student demonstrated ability to understand and complete objectives regarding coding, billing, and reimbursement
Choose
100% (A)
92% (A)
91% (B)
88% (B)
83% (B)
82% (C)
80% (C)
76% (C)
75% (D)
65% (D)
64% or below (E)
Comments
*
Why did you grade the student the way you did for competency 3?
Your answer
9) Competency 4
*
Student demonstrated ability to understand and complete objectives regarding compliance/ROI.
Choose
100% (A)
92% (A)
91% (B)
88% (B)
83% (B)
82% (C)
80% (C)
76% (C)
75% (D)
64% (D)
64% or below (E)
Comments
*
Why did you grade the student the way you did for competency 4?
Your answer
10) Competency 5
*
Student demonstrated ability to understand and complete objectives regarding registries and indices.
Choose
100% (A)
92% (A)
91% (B)
88% (B)
83% (B)
82% (C)
80% (C)
76% (C)
75% (D)
65% (D)
64% or below (E)
Comments
*
Why did you grade the student the way you did for competency 5?
Your answer
11) Competency 6
*
Student demonstrated ability to understand and complete objectives regarding HIM Interdepartmental Relationships.
Choose
100% (A)
92% (A)
91% (B)
88% (B)
83% (B)
82% (C)
80% (C)
76% (C)
75% (D)
65% (D)
64% or below (E)
Comments
*
Why did you grade the student the way you did for competency 6?
Your answer
12) Project Driven PPE (if applicable)
Student demonstrated ability to understand and complete project(s) as assigned by the HIM Supervisor
Choose
100% (A)
92% (A)
91% (B)
88% (B)
83% (B)
82% (C)
80% (C)
76% (C)
75% (D)
65% (D)
64% or below (E)
Comments (if applicable)
Why did you grade the student the way you did for the project driven PPE?
Your answer
13) Additional Comments
Is there any additional information you’d like the PPE Coordinator (instructor) to know about the experience or student?
Your answer
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