Get University Of The Sciences Physician Assistant Shadowing Patient Contact Hours Form 2019

Filling out the University Of The Sciences Physician Assistant Shadowing Patient Contact Hours Form online is a crucial step in documenting your shadowing and patient contact experience. This guide provides clear instructions to help ensure that you complete the form accurately and efficiently.

Follow the steps to successfully fill out the form.

1. Click ‘Get Form’ button to obtain the form and open it in the editor.
2. Begin by entering your legal last name, legal first name, and middle initial in the designated fields.
3. Input your student ID number in the appropriate section to ensure proper identification.
4. In the agency section, provide the name of the healthcare agency where you completed your shadowing hours.
5. Fill in the agency's address, including city, state, and zip code, to detail its location.
6. Enter the name and title of your supervisor, along with their phone number for verification purposes.
7. Indicate the type of shadowing or patient contact experience you had during your time at the facility.
8. Record the start and end dates of your shadowing experience in the provided date fields.
9. Calculate the total number of hours you spent in shadowing and enter this number in the specified field.
10. Evaluate your experience by marking a score from 1 (lowest) to 5 (highest) for areas such as dress, promptness, following instructions, and attitude.
11. Have your supervisor sign and date the form to validate your experience.
12. Ensure the Pre-professional Program Director also approves the form before submitting it.
13. Finally, save your changes, download, print, or share the completed form as needed for your records.

Complete your forms online now to stay on track with your application process.