# This file should process the Communication Sciences Clinical Evaluation form
#
# written by Matthew Bachiochi
#
#

# header information
MAIL-TO bachiomd@jmu.edu Clinical Evaluation Form
+----------------------------------------------------------------------+
||                    Clinical Evaluation Form                         ||
|| Clinician : |CLINICIAN^25|||
|| Setting: |SETTING^25|||
|| Date: |DATE^8|||
|| Supervisor: |SUPERVISOR^25|||
|| Semester: |SEMESTER^25|||
|| Suggested Grade: |SGRADE^3|||
+----------------------------------------------------------------------+

1. Clinical Skills
  A. Diagnosics                Mid-Term    Final
     1.01                      |101m^4|    |101f^4|
     1.02                      |102m^4|    |102f^4|
     1.03                      |103m^4|    |103f^4|
     1.04                      |104m^4|    |104f^4|
     1.05                      |105m^4|    |105f^4|
     1.06                      |106m^4|    |106f^4|
     1.07                      |107m^4|    |107f^4|
     1.08                      |108m^4|    |108f^4|
     1.09                      |109m^4|    |109f^4|
     1.10                      |110m^4|    |110f^4|
     1.11                      |111m^4|    |111f^4|
     1.12
     |112other^35|             |112m^4|    |112f^4|

  B. Prostetics
     2.01                      |201m^4|    |201f^4|
     2.02                      |202m^4|    |202f^4|
     2.03                      |203m^4|    |203f^4|
     2.04                      |204m^4|    |204f^4|
     2.05                      |205m^4|    |205f^4|
     2.06                      |206m^4|    |206f^4|
     2.07                      |207m^4|    |207f^4|
     2.08                      |208m^4|    |208f^4|
     2.09                      |209m^4|    |209f^4|
     2.10                      |210m^4|    |210f^4|
     2.11                      |211m^4|    |211f^4|
     2.12                      |212m^4|    |212f^4|
     2.13
     |213other^35|             |213m^4|    |213f^4|

  C. Treatment Competencies
     3.01                      |301m^4|    |301f^4|
     3.02                      |302m^4|    |302f^4|
     3.03                      |303m^4|    |303f^4|
     3.04                      |304m^4|    |304f^4|
     3.05                      |305m^4|    |305f^4|
     3.06                      |306m^4|    |306f^4|
     3.07                      |307m^4|    |307f^4|
     3.08
     |308other^35|             |308m^4|    |308f^4|

2. Communication
  A. Report Writing
     1.01                      |401m^4|    |401f^4|
     1.02                      |402m^4|    |402f^4|
     1.03                      |403m^4|    |403f^4|
     1.04                      |404m^4|    |404f^4|

  B. Conferencing
     2.01                      |501m^4|    |501f^4|
     2.02                      |502m^4|    |502f^4|
     2.03                      |503m^4|    |503f^4|

3. Professionalism
  A. Independence
     1.01                      |601m^4|    |601f^4|
     1.02                      |602m^4|    |602f^4|
     1.03                      |603m^4|    |603f^4|

  B. Interpersonal Skills
     2.01                      |701m^4|    |701f^4|
     2.02                      |702m^4|    |702f^4|
     2.03                      |703m^4|    |703f^4|

  C. Professionalism
     3.01                      |801m^4|    |801f^4|
     3.02                      |802m^4|    |802f^4|
     3.03                      |803m^4|    |803f^4|

Additional Comments:
|ADDCOMMENTS<40+|
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