Evaluator:____________________ Item Criteria 1. Elicited appropriate history. Requested appropriate additional /4 information based on patient presentation Selected appropriate physical examination based on CC & Hx /4 /4 3. Accurately performed physical examination components. /4 4. Appropriate diagnostic testing selected based on H&P findings /3 Selected correct diagnosis: Prioritized list of differential diagnoses is appropriate given information /2 provided. Prioritized list of proposed treatment plan /2 Professional Criteria Encounter conducted in an efficient yet caring manner, including nurse’s ability to relate to age, developmental stage, educational level, patient’s mental status, and demeanor. /4 Assessment completed within 20 minutes /3 Comments: Final Score: /30
Evaluator:____________________ Item Criteria 1. Elicited appropriate history. Requested appropriate additional information based on patient presentation /4 Selected appropriate physical examination based on CC & Hx /4 3. Accurately performed physical examination components. /4 4. Appropriate diagnostic testing selected based on H&P findings /4 Selected correct diagnosis: /3 Prioritized list of differential diagnoses is appropriate given information provided. /2 Prioritized list of proposed treatment plan /2 Professional Criteria Encounter conducted in an efficient yet caring manner, including nurse’s ability to relate to patient’s age, developmental stage, educational level, mental status, and demeanor. /4 Assessment completed within 20 minutes /3 Comments: Final Score: /30
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