Physician Evaluation Form:
Please rate the trainee on a scale of 1-5 for the following duties:
- poor, (2) fair, (3) good, (4) very good, (5) outstanding
| Duties Required | Evaluation Score |
| Physical Examinations | |
| Diagnosing of Illnesses | |
| Determination of Viable Treatment Options | |
| Prescribing of Medication | |
| Performance of Basic Laboratory Testing Procedures, Including TB | |
| Ordering and Carrying Out Therapy | |
| Assistance in surgery | |
| Suturing, Splinting, and Casting | |
| Disclosing of Patients’ Medical Histories | |
| Preventative Patient Counseling | |
| Hospital and Nursing Home Visitations | |
| Ordering of Tests and Interpretation of Test Results | |