KPAT Clinical Evaluation
Required for student graduation and programmatic accreditation
Email address *
Evaluator (Coordinator) *
Your answer
Evaluatee (Student) *
Clinical Location *
Evaluation Date *
MM
/
DD
/
YYYY
Evaluation Criteria
1 = Unsatisfactory
2 = Needs Improvement
3 = Satisfactory
4 = Exceeds Expectations
1 - Anesthesia Gas Machine *
Captionless Image
Unsatisfactory
Exceeds Expectations
2 - Communication Skills *
Captionless Image
Unsatisfactory
Exceeds Expectations
3 - Technical Skills *
Captionless Image
Unsatisfactory
Exceeds Expectations
4 - Pharmacology Knowledge *
Captionless Image
Unsatisfactory
Exceeds Expectations
5 - Professionalism *
Captionless Image
Unsatisfactory
Exceeds Expectations
Total Score: *
Your answer
Grade Scale:
Please Note:
Comments *
Your answer
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