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Get AYA Healthcare Per Diem Time Card

_____________________________ Hospital: _______________________________________________________________________________________________ DATE LUNCH TIME IN OUT TIME OUT IN TOTAL ON CALL CALL BACK ORIENT CHARGE CALLED OFF SUPERVISOR HOURS HOURS HOURS HOURS HOURS HOURS INITIALS SU MO TU WE TH FR SA TOTAL HOURS: Quality of Work: Documentation: Clinical Ability: Professionalism/Attitude: Attendance/Punctuality: PERFORMANCE EVALUATION (TO BE COMPLETED BY SUPERVISOR WEEKLY) 1 2 3 4 .

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