EXAM EXAMPL

• المقرر الدراسي: صكل 413

New Prescription Counseling Assessment Form

 

Introduction	Yes/No	comments
Student introduced themselves with their name
Student used appropriate title (e.g. student pharmacist)
Identified the person they are talking to
Included a brief explanation of the encounter  (including time estimate)
Questions/Counseling	Yes/No	comments
Verified previous use of the medication?
Asked the 3 prompt questions what/how/what to illicit patient knowledge about the new drug
Student filled in important information gaps about : 1-      The indication for the drug 2-    Dosage/administration 3-    Side effects and what to do 4-      Monitoring (including goals) 5-      Refill 6-      Storage/Administration technique 7-      Additional information (Diet/Exercise) 8-      Missed dose
Questions were open-ended except when necessary
Avoided use of medical jargon
Information given to patient was accurate
Limited information provided to that which is pertinent
Conducted “Final Verification”
Total	/19