Get Nc Ncbrtl Clinical Performance Appraisal Summary & Reference Form 2013-2025

The NC NCBRTL Clinical Performance Appraisal Summary & Reference Form is an essential document for assessing clinical performance and capabilities. This guide provides clear, step-by-step instructions on how to complete the form online, ensuring that users can navigate it with ease.

Follow the steps to complete the NC NCBRTL Clinical Performance Appraisal Summary & Reference Form.

1. Click the ‘Get Form’ button to access the document and open it in your preferred editor.
2. Begin by filling out the participant information, including the name of the Intern/Therapist/Fellow, College/University, and the Clinical/Intern Supervisor details. Ensure you also include the state license number and the NCTRC certification number of the supervisor.
3. Provide the agency's name, address, city, state, and zip code. Document the placement dates and calculate the total hours worked based on the number of weeks and hours per week.
4. In the Assigned Service Area/Patient Population(s) section, specify the areas in which the intern was engaged during their internship.
5. Rate the individual's performance for each listed skill, from 'Exceeds Expectations' to 'Does Not Meet Expectations.' Ensure you calculate the Average Overall Performance Rating by averaging the individual performance ratings.
6. Complete the Behavioral Performance Results section by rating characteristics such as Judgment, Adaptability, Attention to Detail, Initiative, Teamwork, and Professional and Technical Knowledge.
7. List the treatment interventions and the level of proficiency demonstrated (introductory, intermediate, advanced) upon completing the last work cycle or internship in the designated section.
8. Identify the practice competencies that the individual needs to develop in the Development Plan section.
9. Indicate whether the intern should be considered for a vacant position by selecting 'Yes' or 'No.'
10. Sign and date the document where required for both the Student Intern and the Intern Supervisor, confirming that the internship covered the relevant content areas.
11. Make three copies of the completed form: one for the intern, one for submission for NCBRTL Renewal Credit, and one for the supervisor's records.

Complete your NC NCBRTL Clinical Performance Appraisal Summary & Reference Form online today!