7004 - Performance Evaluation - Age-Related Competency Medical Director

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7004 - Performance Evaluation - Age-Related Competency Medical Director Powered By Docstoc
					                                 PERFORMANCE EVALUATION
                                 AGE-RELATED COMPETENCY
                                   (To be completed for all Clinical Personnel)


Name:                                                                             Date:
Position: Sovereign Health of California Medical Director                 Evaluator:
                                                                                  Unit:
Age Range of Patients to Whom Service is Provided: Adolescent to Geriatric



M = Meets Compliance Criteria                  NC = No Compliance             N/A = Not Applicable for this Staff Member

              COMPLIANCE CRITERIA                         M       NC      N/A                COMMENTS

                                                ADOLESCENT

Maintains safe environment: assesses for
depression/suicidal ideation and keeps dangerous
items out of patient’s ability to obtain.

Assesses for “gang” relationships and considers
appropriateness of visitors.

Assesses patient for symptoms of overmedicating
and undermedicating.

Demonstrates knowledge of therapeutic drug
levels of psychotropic medications for the patient.

Demonstrates clinical knowledge of expected vital
signs.

Involves patient in care, treatments and
procedures. Allows time for and encourages
questions, explaining issues to patient in language
patient can understand. Allows patient to have
choice and control over situations and
environment, as appropriate to condition and
situation.

Explains all treatments, tests and procedures
thoroughly to patient before they are performed.

Makes special dietary considerations.

Does not use condescending language.

Recognizes importance of body image.
PERFORMANCE EVALUATION - AGE-RELATED COMPETENCY - SOVEREIGN HEALTH OF
CALIFORNIA MEDICAL DIRECTOR (continued)

            COMPLIANCE CRITERIA                          M    NC   N/A     COMMENTS

Allows for privacy needs. Encourages and allows
for personal hygiene activities.

Maintains patient confidentiality with caregiver
involvement and education, as appropriate to age
and consent of patient.

Provides feedback about health status.

Recognizes abuse/neglect potential.

Provides patient and caregivers with community
and financial resources specific to adolescent
population.

Addresses religious and cultural system beliefs
and incorporates these into care planning
decisions

Encourages verbalization of fears. Discusses
options and possible choices patient can make to
increase control and foster patient confidence.

                                                      ADULT

Maintains safe environment related to equipment
and mental status.

Assesses for depression/suicidal ideation and
keeps dangerous items out of patient’s ability to
obtain. Assesses for “gang” relationships and
considers appropriateness of visitors.

Involves patient in care, treatments and
procedures. Allows patient to maintain control;
involves patient in decision-making and planning
of care, as appropriate to condition and situation.

Explains rationale for all treatments, tests and
procedures, explaining to patient prior to
performance.

Encourages participation in care, provides
education, as appropriate to disease entity and
processes.

Assesses patient for symptoms of overmedicating
and undermedicating.

                                                                         PRIVATE AND CONFIDENTIAL
PERFORMANCE EVALUATION - AGE-RELATED COMPETENCY - SOVEREIGN HEALTH OF
CALIFORNIA MEDICAL DIRECTOR (continued)

            COMPLIANCE 
				
DOCUMENT INFO
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