Loading
Form preview picture

Get Da Form 5374

U.S. DOD Form dod-da-5374-r PERFORMANCE ASSESSMENT For use of this form see AR 40-68 the proponent agency is OTSG FROM AREAS OF ASSESSMENT Check Appropriate Box. Qualifying statements may be made under Comments below. GOOD EXCELLENT Clinical judgment. SATISFACTORY Basic clinical knowledge displayed* PERIOD COVERED TO Clinical performance. a* Outpatient. b. Inpatient. c* Operating room* Communication skills. Rapport with patients. Relationship with colleagues. Cooperation with hospital/clinic personnel* Appearance. 9. Emotional stability. 10. Apparent physical health. 11. Professional conduct 12. Ethical conduct. 13. Leadership capability. 14. Quality and timeliness of medical/dental record documentation* 15. Participation/attendance at staff committee meetings and professional activities. 17a* COMMENTS Unsatisfactory areas should be addressed* NAME OF ASSESSED INDIVIDUAL 17b. GRADE SPECIALTY/DUTY ASSIGNMENT MEDICAL/DENTAL TREATMENT FACILITY Name and Address 17c* TITLE 18a* TYPED NAME OF SUPERVISOR 18c* TITLE 18d. Qualifying statements may be made under Comments below. GOOD EXCELLENT Clinical judgment. SATISFACTORY Basic clinical knowledge displayed* PERIOD COVERED TO Clinical performance. a* Outpatient. b. Inpatient. c* Operating room* Communication skills. Rapport with patients. Relationship with colleagues. a* Outpatient. b. Inpatient. c* Operating room* Communication skills. Rapport with patients. Relationship with colleagues. Cooperation with hospital/clinic personnel* Appearance. 9. Emotional stability. 10. Apparent physical health. Cooperation with hospital/clinic personnel* Appearance. 9. Emotional stability. 10. Apparent physical health. 11. Professional conduct 12. Ethical conduct. 13. Leadership capability. 14. Quality and timeliness of medical/dental record documentation* 15. 11. Professional conduct 12. Ethical conduct. 13. Leadership capability. 14. Quality and timeliness of medical/dental record documentation* 15. Participation/attendance at staff committee meetings and professional activities. 17a* COMMENTS Unsatisfactory areas should be addressed* NAME OF ASSESSED INDIVIDUAL 17b. Participation/attendance at staff committee meetings and professional activities. 17a* COMMENTS Unsatisfactory areas should be addressed* NAME OF ASSESSED INDIVIDUAL 17b. GRADE SPECIALTY/DUTY ASSIGNMENT MEDICAL/DENTAL TREATMENT FACILITY Name and Address 17c* TITLE 18a* TYPED NAME OF SUPERVISOR 18c* TITLE 18d. Qualifying statements may be made under Comments below. GOOD EXCELLENT Clinical judgment. SATISFACTORY Basic clinical knowledge displayed* PERIOD COVERED TO Clinical performance. a* Outpatient. b. Inpatient. c* Operating room* Communication skills. Rapport with patients. Relationship with colleagues. Cooperation with hospital/clinic personnel* Appearance. 9. Emotional stability. 10. Apparent physical health. a* Outpatient. b. Inpatient. c* Operating room* Communication skills. Rapport with patients. Relationship with colleagues. Cooperation with hospital/clinic personnel* Appearance. 9. Emotional stability. 10. Apparent physical health. 11. Professional conduct 12. Ethical conduct. 13. Leadership capability. 14. Quality and timeliness of medical/dental record documentation* 15.

How It Works

V1 rating
4.8Satisfied
22 votes

Tips on how to fill out, edit and sign Inpatient online

How to fill out and sign Unsatisfactory online?

Get your online template and fill it in using progressive features. Enjoy smart fillable fields and interactivity. Follow the simple instructions below:

The preparing of lawful papers can be high-priced and time-consuming. However, with our pre-built online templates, things get simpler. Now, using a Da Form 5374 requires no more than 5 minutes. Our state web-based samples and crystal-clear instructions eliminate human-prone mistakes.

Comply with our easy steps to have your Da Form 5374 well prepared quickly:

  1. Pick the web sample in the catalogue.
  2. Type all necessary information in the necessary fillable fields. The easy-to-use drag&drop graphical user interface allows you to include or relocate fields.
  3. Make sure everything is filled out appropriately, without any typos or lacking blocks.
  4. Apply your e-signature to the page.
  5. Click on Done to save the changes.
  6. Download the document or print your PDF version.
  7. Distribute instantly to the receiver.

Use the fast search and powerful cloud editor to make an accurate Da Form 5374. Get rid of the routine and create paperwork online!

Get form

Experience a faster way to fill out and sign forms on the web. Access the most extensive library of templates available.

18a FAQ

Get This Form Now!

Use professional pre-built templates to fill in and sign documents online faster. Get access to thousands of forms.

Keywords relevant to Da Form 5374

  • 18b
  • Timeliness
  • V1
  • 17c
  • jul
  • OTSG
  • 18a
  • 17a
  • inpatient
  • proponent
  • Dec
  • Unsatisfactory
  • assessed
  • OUTPATIENT
  • rapport
If you believe that this page should be taken down, please follow our DMCA take down processhere.
Ensure the security of your data and transactions

USLegal fulfills industry-leading security and compliance standards.

  • 
                            VeriSign logo picture

    VeriSign secured

    #1 Internet-trusted security seal. Ensures that a website is free of malware attacks.

  • Accredited Business

    Guarantees that a business meets BBB accreditation standards in the US and Canada.

  • 
                            TopTenReviews logo picture

    TopTen Reviews

    Highest customer reviews on one of the most highly-trusted product review platforms.