NEW Clinical Facility Pre-Evaluation Form

Location
Underserved Area
Date
//  
 YesNo
Does this site have adequate space for a student to do a clinical rotation?
Does this site allow adequate time between patients to foster teaching/learning?
Does this site have a sufficient number of patients?
Are patients diverse in age, concerning problem, ethnicity or background etc.?
Are students be allowed to select patients according to their need?
Will students have the opportunity to follow-up with select patients to promote continuity in learning?
Does this site allow students have access to lab and x-ray reports?
Is the philosophy of clinic/site to provide health promotion and disease prevention?
Which of the following types of health care providers are present at this site:
Approved
Date
//