Pharmacy Technician Point-of-Care Testing Training Program Attestation Form

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Pharmacy Technician Point-of-Care Testing Training Program Attestation Form

To be completed by precepting pharmacist at the conclusion of the Pharmacy Technician Enhanced Training: Point-of-Care Testing program.

Name of Pharmacy Technician *

Pharmacy Technician Email Address *

Name of Assessing Pharmacist *

Assessing Pharmacist Email Address *

Focused Health History *

Exceptional

Acceptable

Needs Improvement

Builds rapport with the patient (introduces self to patient and explains what to expect)

Conducts an organized focused health history

Collects all necessary information:

• History of present illness

• Family and social histories

• Past medical history

• Recent hospitalizations/procedures

• Medical allergies

• Current medications

• OTC medications

• Vaccine history

• Physical examination

Asks appropriate follow-up questions as needed using open-ended questions.

Exceptional

Acceptable

Needs Improvement

Builds rapport with the patient (introduces self to patient and explains what to expect)

Conducts an organized focused health history

Collects all necessary information:

• History of present illness

• Family and social histories

• Past medical history

• Recent hospitalizations/procedures

• Medical allergies

• Current medications

• OTC medications

• Vaccine history

• Physical examination

Asks appropriate follow-up questions as needed using open-ended questions.

Vital Signs

Told Patient What to Expect

Performed Method Correctly

Value Obtained

Appeared Confident

Blood Pressure

Pulse

Respiratory Rate

Temperature

Pulse Ox

The precepting pharmacist attests that the pharmacy technician has satisfactorily completed the hands-on training portion of the certificate program and should be issued a certificate in Point-of-Care Testing. *

Yes

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