EXAM EXAPLE

• المقرر الدراسي: صكل 413

Refill Prescription Counseling Assessment Form

 

Introduction	Yes/No	comments
Student introduced themselves with their name
Greeted the patient by her name
Questions/Counseling Follow up	Yes/No	comments
Asked about how the medication is working for the patient
Asked if patient experienced any side effects
Asked about any changes in medications or health since last time
Avoided use of medical jargon
Information given to patient was accurate, if pertinent
Asked the patient is she has any questions or concerns
Total	/8