ࡱ> 68345[ hIbjbj %njj"l```````tB)B)B)B) N*t]_- :::::<|=|P]R]R]R]R]R]R]$` 3bv]`=::==v]I``::_III= `:`:P]I=P]IILO``LO:- o~t'B)ILOLO-_0]_LObIbLOItt```` Employee Name:  FORMTEXT      Reappraisal/Reappointment Period:  FORMTEXT       -  FORMTEXT       S = Satisfactory U = Unsatisfactory FP = Frequent Problems N/A = Not ApplicablePhysician AssistantCriteriaSUFPN/AComments CLINICAL KNOWLEDGE1. Under the supervision of the Attending, provides comprehensive health assessments and develops plan of care for patient population incorporating the following information: FORMTEXT      a. medical health history FORMCHECKBOX  FORMCHECKBOX  FORMCHECKBOX  FORMCHECKBOX  FORMTEXT      b. psycho social history FORMCHECKBOX  FORMCHECKBOX  FORMCHECKBOX  FORMCHECKBOX  FORMTEXT      c. physical examination FORMCHECKBOX  FORMCHECKBOX  FORMCHECKBOX  FORMCHECKBOX  FORMTEXT      d. health risk appraisal FORMCHECKBOX  FORMCHECKBOX  FORMCHECKBOX  FORMCHECKBOX  FORMTEXT      e. cultural diversity, ethnicity, gender and lifestyle choices FORMCHECKBOX  FORMCHECKBOX  FORMCHECKBOX  FORMCHECKBOX  FORMTEXT      2. Under the supervision of the Attending, develops appropriate plan of care for patient based on: FORMTEXT      a. existing problems/needs FORMCHECKBOX  FORMCHECKBOX  FORMCHECKBOX  FORMCHECKBOX  FORMTEXT      b. formulates and prioritizes clinical impressions/diagnosis based on clinical findings FORMCHECKBOX  FORMCHECKBOX  FORMCHECKBOX  FORMCHECKBOX  FORMTEXT      c. analysis of diagnostic testing and laboratory results FORMCHECKBOX  FORMCHECKBOX  FORMCHECKBOX  FORMCHECKBOX  FORMTEXT      3. Serves as a resource person for other healthcare professionals, patients, and families FORMCHECKBOX  FORMCHECKBOX  FORMCHECKBOX  FORMCHECKBOX  FORMTEXT       CLINICAL JUDGEMENT1. Initiates interventions under the supervision of Attendings by: FORMTEXT      a. orders diagnostic tests based on assessment of available data FORMCHECKBOX  FORMCHECKBOX  FORMCHECKBOX  FORMCHECKBOX  FORMTEXT      b. performs lab exams for diagnostic screening and referral FORMCHECKBOX  FORMCHECKBOX  FORMCHECKBOX  FORMCHECKBOX  FORMTEXT       c. consults with MD for abnormal findings FORMCHECKBOX  FORMCHECKBOX  FORMCHECKBOX  FORMCHECKBOX  FORMTEXT      d. triages patient phone calls FORMCHECKBOX  FORMCHECKBOX  FORMCHECKBOX  FORMCHECKBOX  FORMTEXT      e. refers patient to appropriate specialists, agencies and community resources FORMCHECKBOX  FORMCHECKBOX  FORMCHECKBOX  FORMCHECKBOX  FORMTEXT      f. interventions of patient needs are made considering benefit and cost while keeping Attending aware of acute medical problems/needs FORMCHECKBOX  FORMCHECKBOX  FORMCHECKBOX  FORMCHECKBOX  FORMTEXT      g. counsels patients regarding tests, procedures, and disease process FORMCHECKBOX  FORMCHECKBOX  FORMCHECKBOX  FORMCHECKBOX  FORMTEXT      h. treats common complications of therapy FORMCHECKBOX  FORMCHECKBOX  FORMCHECKBOX  FORMCHECKBOX  FORMTEXT      i. schedules follow up visits to appropriately monitor patients and evaluate care FORMCHECKBOX  FORMCHECKBOX  FORMCHECKBOX  FORMCHECKBOX  FORMTEXT      j. incorporates members of other health care disciplines within and outside of SUNY Upstate Medical University FORMCHECKBOX  FORMCHECKBOX  FORMCHECKBOX  FORMCHECKBOX  FORMTEXT      k. seeks available resources to help formulate ethical decisions FORMCHECKBOX  FORMCHECKBOX  FORMCHECKBOX  FORMCHECKBOX  FORMTEXT      l. maintains contemporary knowledge and skills FORMCHECKBOX  FORMCHECKBOX  FORMCHECKBOX  FORMCHECKBOX  FORMTEXT      2. Utilizes prescriptive authority under the supervision of Attending FORMTEXT      a. prescribes based on clinical indicators/patient status and needs, diagnostic and laboratory tests FORMCHECKBOX  FORMCHECKBOX  FORMCHECKBOX  FORMCHECKBOX  FORMTEXT      b. informs patient of intended effects and potential side effects of the prescribed medications FORMCHECKBOX  FORMCHECKBOX  FORMCHECKBOX  FORMCHECKBOX  FORMTEXT      c. prescribes in accordance with the state and federal regulations FORMCHECKBOX  FORMCHECKBOX  FORMCHECKBOX  FORMCHECKBOX  FORMTEXT      3. Evaluates patient s progress in attaining expected outcomes based on: FORMTEXT      a. effectiveness of intervention FORMCHECKBOX  FORMCHECKBOX  FORMCHECKBOX  FORMCHECKBOX  FORMTEXT      b. patient s overt response to care FORMCHECKBOX  FORMCHECKBOX  FORMCHECKBOX  FORMCHECKBOX  FORMTEXT      c. changing needs FORMCHECKBOX  FORMCHECKBOX  FORMCHECKBOX  FORMCHECKBOX  FORMTEXT      d. revising plan of care based on evaluation FORMCHECKBOX  FORMCHECKBOX  FORMCHECKBOX  FORMCHECKBOX  FORMTEXT      1. Documents in the medical record by recording subjective, objective data, assessment and plan records data in a consistent, legible, accurate, concise and timely manner using appropriate terminology FORMCHECKBOX  FORMCHECKBOX  FORMCHECKBOX  FORMCHECKBOX  FORMTEXT      TECHNICAL PROFICIENCY2. Completes all required mandatory training as specified by SUNY Upstate Medical University FORMCHECKBOX  FORMCHECKBOX  FORMCHECKBOX  FORMCHECKBOX  FORMTEXT      3. Monitors standards of care to improve patient outcomes FORMCHECKBOX  FORMCHECKBOX  FORMCHECKBOX  FORMCHECKBOX  FORMTEXT      4. Performs selected procedures safely FORMCHECKBOX  FORMCHECKBOX  FORMCHECKBOX  FORMCHECKBOX  FORMTEXT      5. Informs patient of risks, benefits and outcomes of health care regimens FORMCHECKBOX  FORMCHECKBOX  FORMCHECKBOX  FORMCHECKBOX  FORMTEXT      1. Provides patient/family education by: FORMTEXT      PROFESSIONAL ATTITUDEa. utilizing appropriate materials as available FORMCHECKBOX  FORMCHECKBOX  FORMCHECKBOX  FORMCHECKBOX  FORMTEXT      b. providing accurate and current information FORMCHECKBOX  FORMCHECKBOX  FORMCHECKBOX  FORMCHECKBOX  FORMTEXT      c. shares knowledge from educational programs and journals with peers FORMCHECKBOX  FORMCHECKBOX  FORMCHECKBOX  FORMCHECKBOX  FORMTEXT      d. validates teaching was appropriate and understood FORMCHECKBOX  FORMCHECKBOX  FORMCHECKBOX  FORMCHECKBOX  FORMTEXT      2. Cooperates with research being done within the department as appropriate FORMCHECKBOX  FORMCHECKBOX  FORMCHECKBOX  FORMCHECKBOX  FORMTEXT      3. Works collaboratively with other healthcare professional staff FORMCHECKBOX  FORMCHECKBOX  FORMCHECKBOX  FORMCHECKBOX  FORMTEXT      4. Analyzes factors related to safety, satisfaction, effectiveness and cost benefit options FORMCHECKBOX  FORMCHECKBOX  FORMCHECKBOX  FORMCHECKBOX  FORMTEXT      5. Maintains patient confidentiality FORMCHECKBOX  FORMCHECKBOX  FORMCHECKBOX  FORMCHECKBOX  FORMTEXT      6. Acts as patient advocate FORMCHECKBOX  FORMCHECKBOX  FORMCHECKBOX  FORMCHECKBOX  FORMTEXT      7. Delivers care in a non-judgmental and non-discriminatory manner that is sensitive to patient diversity FORMCHECKBOX  FORMCHECKBOX  FORMCHECKBOX  FORMCHECKBOX  FORMTEXT      7. Delivers care in a manner that preserves/protects patient autonomy, dignity and rights  FORMCHECKBOX  FORMCHECKBOX  FORMCHECKBOX  FORMCHECKBOX  FORMTEXT      8. Seeks opportunities for continuous learning which enable understanding and enforcement of hospital/university policies and procedures in order to effectively conduct the business of the unit FORMCHECKBOX  FORMCHECKBOX  FORMCHECKBOX  FORMCHECKBOX  FORMTEXT      9. Participates in educational activities related to practice FORMCHECKBOX  FORMCHECKBOX  FORMCHECKBOX  FORMCHECKBOX  FORMTEXT      10. Maintains active membership in appropriate professional organizations  FORMCHECKBOX  FORMCHECKBOX  FORMCHECKBOX  FORMCHECKBOX  FORMTEXT       Employee Signature  FORMTEXT       Supervisor s Signature  FORMTEXT       Date FORMTEXT       Date  FORMTEXT       Ratings are based upon: Test Observation Simulation (Please circle one) "$8:<FH$2468:VjdCJOJQJUjCJOJQJUj|CJOJQJU5CJOJQJjCJOJQJUjtCJOJQJU jCJOJQJUmHnHujCJOJQJUjCJOJQJU CJOJQJ1J`}w$If $$Ifa$q$$Ifl44D04 8 x064 la$IfhI $$Ifa$$If$If\$$Ifl489064 la$3|----$If$$Ifl46֞p!$$d&(84@@@@>04 la$If $$Ifa$3-0$If^`0$If$$Ifl46֞p!$$d&(8`4@@@@>04 la8\$If $$Ifa$VXZ\^z|~    " $ & ( * F H J L N j l n p r ߤߖ߈zljCJOJQJUjCJOJQJUjCJOJQJUjCJOJQJUj4CJOJQJU jCJOJQJUmHnHujCJOJQJUjLCJOJQJU CJOJQJjCJOJQJUjCJOJQJU*3-0$If^`0$If$$Ifl4֞p!$$d&(84@@@@>04 la ( L p $If $$Ifa$ 3-0$If^`0$If$$Ifl4֞p!$$d&(84@@@@>04 la      4 6 8 : < X Z \ ^ ` t v x     $ & ( * zlj CJOJQJUj6 CJOJQJUjCJOJQJU jCJOJQJUmHnHujNCJOJQJUjCJOJQJUjbCJOJQJUjCJOJQJUjxCJOJQJU CJOJQJjCJOJQJU*  : ^ $If $$Ifa$ 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