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Clinical Observation Tracking Sheet PTA 1010 Introduction to Physical therapy student Name: ///Ange PTor PTA observed: hawes Durfe~ Name of Clinic: KP vertin Date Time In | Time Out | PT/PTA | Comments from clinician initials AJA | 00 | B00 eB 4(28]1@ | (00 4:30 Te Iofi fie | £00 4:00 7p lo/s/ig | 100 3:30 Te 10/23/1@ | 12:00 3:00 Tp 10/30/16 | |2:00 | 2:00 B use | kao | £46 1p hfol'® | 12:00 | 200 | Tp Signature of Student: Ziaur) Zhe 9 Name of PT/PTA observed: Signature of PT/PTA observed: Physical Therapist Assistant Program 4 student's Name: /JLIANCL /TILS vate: (I) (9 Thave had contact with this student for:_@2_hours. Name of Person Completing Form;_Chonnes _ Bute~ Contact information, / Email,