Taking the Patient Health History Rubric: Part I

Student: __________________________________________
Grading Instructor: ________________________________
Select the category/point value that best describes the observed performance
Establishing
the Interview
Environment

Initiating the
Interview and
Establishing
Rapport

Patientcentered
Interview
Techniques

Legal/Ethical
Issues and
Concerns

Excellent (3)
Interview setting is
private; patient is
seated in upright
position; clinician is
seated at eye level

Unsatisfactory (0)
Interview takes
place in
distracting
environment;
patient reclined
or clinician stands
during interview
DH introduces
DH introduces
DH appears not to
herself; uses eye
herself but does not make much of an
contact, smiles, and use much eye
effort to establish
shakes hands;
contact or forgets to a rapport with
checks that all
shake hands;
patient, or fails to
areas of HH
checks HH for
check HH for
completed
completeness
completeness
Ask permission to
Introduction to HH
Superficial or no
review HH and ask
process truncated;
introduction to HH
questions; explain
asks about
procedure;
importance of HH
concerns and
reviews HH but
and the veracity of
reason for visit, but asks few or
patient; ask about
use of open-ended
closed-ended
concerns, any pain, questions or active
questions;
reason for visit;
listening techniques appears
uses active listening limited
distracted during
interview
HH completely filled Checks HH for
Cursory or failure
out, signed/dated;
completeness,
to review HH for
HH reviewed and
signature and date; completeness;
clarified/verified in
somewhat
fails to verify or
areas germane to
superficial review of ask for
treatment; potential HH information;
clarification of
emergency
does not completely any areas of
situations noted and verify or clarify
concern or
contact info
areas of concern or
problems/pain;
obtained; discusses emergency contact potential
HIPPA and
information; gives
emergency
confidentiality of
HIPPA form w/o
situations not
information
explanation
clarified; no
reference to
HIPPA form

Total points possible: 12

Satisfactory (2)
Interview setting
does not promote
confidentiality;
patient is not fully
upright, clinician
seated

Points required to pass: 75% or 9

Circle One: Pass/Retake