Get Clinical Observation Verification Form - University Of Dayton - Udayton

Completing the Clinical Observation Verification Form is an essential part of the application process for the Doctor of Physical Therapy program at the University of Dayton. This guide provides straightforward instructions to help you fill out the form correctly and efficiently.

Follow the steps to complete the Clinical Observation Verification Form accurately.

1. Click ‘Get Form’ button to obtain the form and open it in the editor.
2. Begin by filling in your personal information at the top of the form. Provide your last name, first name, and middle name in the designated fields.
3. Review the observation requirements for the Doctor of Physical Therapy program carefully. Ensure you plan for a total of 80 hours of observation, with at least 20 hours in an inpatient setting.
4. Document your observation hours accurately. Indicate the specific numbers of hours completed in each type of setting. For example, specify if the hours were in inpatient or outpatient care, noting the corresponding settings like inpatient rehabilitation or outpatient pediatrics.
5. If you have work experience in a physical therapy department, include those hours under 'Clinical Observation/Work Experience.' Make sure that the hours recorded demonstrate at least 20 in inpatient care.
6. Fill in the facility information, including the name, telephone number, and mailing address of the institution where you completed your observations.
7. Provide the dates of observation from the start (MM/DD/YY) to end (MM/DD/YY). Additionally, include the total number of hours spent observing.
8. In the section for patient-related activities, describe the tasks you observed or performed during your clinical experience. Be detailed yet concise.
9. Sign and date the form where indicated to verify your information.
10. The supervising physical therapist must complete the supervisor information section, providing their signature, printed name, date, telephone number, and license number.
11. Once all fields are filled out, you can save your changes, download, print, or share the completed form.

Start filling out your Clinical Observation Verification Form online to ensure a successful application!