Practicum/Clinical Evaluation of Student | HCC

Practicum/Clinical Evaluation of Student

2015 MAERB Core Curriculum

Henderson Community College Medical Assisting Program

Name of Practicum Student Being Evaluated:

Instructions: Consider each item separately and rate each item independently of all others. Indicate in the appropriate box the student’s level of competency, if applicable, or access to the specific task.

Psychomotor & Affective Competencies

I. Anatomy & Physiology
I. Anatomy & Physiology Competent Needs Work Student was able to observe Not Available at this site
I.P.1. Measure and record:        
a. blood pressure        
b. temperature        
c. pulse        
d. respirations        
e. height        
f. weight        
g. length (infant)        
h. head circumference (infant)        
i. pulse oximetry        
I.P.2. Perform:        
a. electrocardiography        
b. venipuncture        
c. capillary puncture        
d. pulmonary function testing        
I.P.3. Perform patient screening using established protocols        
I.P.4. Verify the rules of medication administration:        
a. right patient        
b. right medication        
c. right dose        
d. right route        
e. right time        
f. right documentation        
I.P.5. Select proper sites for administering parenteral medication        
I.P.6. Administer oral medications        
I.P.7. Administer parenteral (excluding IV) medications        
I.P.8. Instruct and prepare a patient for a procedure or a treatment        
I.P.9. Assist provider with a patient exam        
I.P.10. Perform a quality control measure        
I.P.11. Obtain specimens and perform:        
a. CLIA waived hematology test        
b. CLIA waived chemistry test        
c.  CLIA waived urinalysis        
d.  CLIA waived immunology test        
e. CLIA waived microbiology test        
I.P.12. Produce up-to-date documentation of provider/professional level CPR


I.P.13. Perform first aid procedures for:        
a. bleeding        
b. diabetic coma or insulin shock        
c. fractures        
d. seizures        
e. shock        
f. syncope        
I.A.1. Incorporate critical thinking skills when performing patient assessment        
I.A.2. Incorporate critical thinking skills when performing patient care         
I.A.3. Show awareness of a patient’s concerns related to the procedure being performed        
II. Applied Mathematics
II. Applied Mathematics Competent Needs Work Student was able to observe Not Available at this site
II.P.1. Calculate proper dosages of medication for administration        
II.P.2. Differentiate between normal and abnormal test results         
II.P.3. Maintain lab test results using flow sheets        
II.P.4. Document on a growth chart        
II.A.1. Reassure a patient of the accuracy of the test results        
III. Infection Control
III. Infection Control Competent Needs Work Student was able to observe Not Available at this site
III.P.1. Participate in bloodborne pathogen training        
III.P.2. Select appropriate barrier/personal protective equipment (PPE)        
III.P.3. Perform handwashing        
III.P.4. Prepare items for autoclaving        
III.P.5. Perform sterilization procedures        
III.P.6. Prepare a sterile field        
III.P.7. Perform within a sterile field        
III.P.8. Perform wound care        
III.P.9. Perform dressing change        
III.P.10. Demonstrate proper disposal of biohazardous material        
a. sharps        
b. regulated wastes        
III.A.1. Recognize the implications for failure to comply with Center for Disease Control (CDC) regulations in healthcare settings        
IV. Nutrition
IV. Nutrition Competent Needs Work Student was able to observe Not Available at this site
IV.P.1. Instruct a patient according to patient’s special dietary needs        
IV.A.1. Show awareness of patient’s concerns regarding a dietary change          
V. Concepts of Effective Communication
V. Concepts of Effective Communication Competent Needs Work Student was able to observe Not Available at this site
V.P.1. Use feedback techniques to obtain patient information including:        
a. reflection        
b. restatement        
c. clarification        
V.P.2. Respond to nonverbal communication        
V.P.3. Use medical terminology correctly and pronounced accurately to communicate information to providers and patients        
V.P.4. Coach patients regarding:        
a. office policies        
b. health maintenance        
c. disease prevention        
d. treatment plan        
V.P.5. Coach patients appropriately considering:        
a. cultural diversity        
b. developmental life stage        
c. communication barriers        
V.P.6. Demonstrate professional telephone techniques        
V.P.7. Document telephone messages accurately        
V.P.8. Compose professional correspondence utilizing electronic technology        
V.P.9. Develop a current list of community resources related to patients’ healthcare needs        
V.P.10. Facilitate referrals to community resources in the role of a patient navigator         
V.P.11. Report relevant information concisely and accurately        
V.A.1. Demonstrate:         
a. empathy        
b. active listening        
c. nonverbal communication        
V.A.2.  Demonstrate the principles of self-boundaries        
V.A.3.  Demonstrate respect for individual diversity including:        
a. gender        
b. race        
c. religion        
d. age        
e. economic status        
f. appearance        
V.A.4.  Explain to a patient the rationale for performance of a procedure         
VI. Administrative Functions
VI. Administrative Functions Competent Needs Work Student was able to observe Not Available at this site
VI.P.1. Manage appointment schedule using established priorities        
VI.P.2. Schedule a patient procedure        
VI.P.3. Create a patient’s medical record         
VI.P.4. Organize a patient’s medical record        
VI.P.5. File patient medical records        
VI.P.6. Utilize an EMR         
VI.P.7. Input patient data utilizing a practice management system        
VI.P.8. Perform routine maintenance of administrative or clinical equipment        
VI.P.9. Perform an inventory with documentation        
VI.A.1. Display sensitivity when managing appointments        
VII. Basic Practice Finances
VII. Basic Practice Finances Competent Needs Work Student was able to observe Not Available at this site
VII.P.1. Perform accounts receivable procedures to patient accounts including posting:        
a. charges        
b. payments        
c. adjustments        
VII.P.2. Prepare a bank deposit        
VII.P.3. Obtain accurate patient billing information        
VII.P.4. Inform a patient of financial obligations for services rendered        
VII.A.1. Demonstrate professionalism when discussing patient's billing record        
VII.A.2.  Display sensitivity when requesting payment for services rendered        
VIII. Third Party Reimbursement
VIII. Third Party Reimbursement Competent Needs Work Student was able to observe Not Available at this site
VIII.P.1. Interpret information on an insurance card        
VIII.P.2. Verify eligibility for services including documentation        
VIII.P.3. Obtain precertification or preauthorization including documentation        
VIII.P.4. Complete an insurance claim form        
VIII.A.1. Interact professionally with third party representatives        
VIII.A.2. Display tactful behavior when communicating with medical providers regarding third party requirements        
VIII.A.3. Show sensitivity when communicating with patients regarding third party requirements        
IX. Procedural and Diagnostic Coding
IX. Procedural and Diagnostic Coding Competent Needs Work Student was able to observe Not Available at this site
IX.P.1. Perform procedural coding        
IX.P.2. Perform diagnostic coding        
IX.P.3. Utilize medical necessity guidelines         
IX.A.1. Utilize tactful communication skills with medical providers to ensure accurate code selection        
X. Legal Implications
X. Legal Implications Competent Needs Work Student was able to observe Not Available at this site
X.P.1. Locate a state’s legal scope of practice for medical assistants         
X.P.2. Apply HIPAA rules in regard to:        
a. privacy        
b. release of information        
X.P.3. Document patient care accurately in the medical record        
X.P.4. Apply the Patient’s Bill of Rights as it relates to:        
a. choice of treatment        
b. consent for treatment        
c. refusal of treatment        
X.P.5. Perform compliance reporting based on public health statutes        
X.P.6. Report an illegal activity in the healthcare setting following proper protocol        
X.P.7. Complete an incident report related to an error in patient care        
X.A.1.  Demonstrate sensitivity to patient rights        
X.A.2. Protect the integrity of the medical record         
XI. Ethical Considerations
XI. Ethical Considerations Competent Needs Work Student was able to observe Not Available at this site
XI.P.1. Develop a plan for separation of personal and professional ethics        
XI.P.2. Demonstrate appropriate response(s) to ethical issues        
XI.A.1.  Recognize the impact personal ethics and morals have on the delivery of healthcare        
XII. Protective Practices
XII. Protective Practices Competent Needs Work Student was able to observe Not Available at this site
XII.P.1. Comply with:        
a. safety signs        
b. symbols        
c. labels        
XII.P.2. Demonstrate proper use of:        
a. eyewash equipment        
b. fire extinguishers        
c. sharps disposal containers        
XII.P.3. Use proper body mechanics        
XII.P.5. Evaluate the work environment to identify unsafe working conditions        
XII.A.1. Recognize the physical and emotional effects on persons involved in an emergency situation        
XII.A.2. Demonstrate self-awareness in responding to an emergency situation        

Additional Comments

What type of administrative duties did the student perform?  What type of administrative duties did the student observe?



What type of clinical duties did the student perform?  What type of clinical duties did the student observe? 



What type of oversight did the Practicum Coordinator of the medical assisting program provide for the student and the site supervisor?  Were you able to contact the Practicum Coordinator with any problems?  Was there regular contact?  


Name of Clinical Facility/Office:



Dates of Clinical Experience

Start Date:

End Date:


Voluntary Clinical Faculty (Print Name):


Voluntary Clinical Faculty (Signature):



Supervising Henderson Community College Faculty: