Checklist for Completion of PGY1 Community-Based Pharmacy Residency Requirements Due: June 30, 2021 Resident Name: wih Cfa— Please initia: Resident / Residency Program Director &_/1_GK, Resident completed all learning experiences. 1 _GY2. Resident has attained 80% achieved (ACH) of required residency goals and objectives by the end of the residency year. & /1_GKS. Resident completed all required evaluations in PharmAcademic (learning experience, preceptor, self-evaluations) !_ GHG. Resident futiled hisiher stating requirements. VI _Gl5. Resident completed one pharmacy-related residency research project within the residency period, including obtaining IRB approval, a platform presentation at the FRC; anda summary ofthe project in manusep syle Gi 6. Resident presented a poster at the ASHP Midyear Clinic and/or APhA Annual Meeting, BV | GIT Resisent evaluated an existing, or developed a new collaborative drug therapy practice agreement, standing order, or implementation process for a stale- based protog; @_Z)_GK8. Resident developed a business plan for a new or enhanced pharmacy serie ard jolrieted and essessed te service € 8, Resident developed, implemented, and assessed a quality improvement I Meeting ro o wy 410, Resident presented a platform presentation at the DCPA Annual Resigen fir, Me 11, Resident developed learning objectives along with teaching materials and {aught atJeast one 1-2 hour didactic lecture to Doctor of Pharmacy students, & 1/1 GY 12. Resident successfully completed the Teaching Certificate Program, incluging pasicipating in the Patient Care Management Lab COSI 13. Resident maintained and contributed to the Department of Pharmacy Servyjces guasterly newsletter. a vy Resident participated in community service activities. Vall Resident maintained a residency portfolio. 114016. Resident maintained the time tracking activity log.at) Gk47. The resident completed an exit interview withthe Program Director The interview should include discussion of the written reflection by the resident of the ast year to include: ) Areas of strength on continued improvement identified for the resident b) Areas of strength and areas requiring improvement identified for the individual program (specific suggestions on how to improve the program are encouraged) Please include documentation of each of these activities in a “resident binder’. Other materials may be included, such as copies of lectures, presentations, patient notes, etc. The notebook will be reviewed during the exit interview. The Residency Program Director will retain a copy of these materials at the end of the program, | support that each of the above requirements has been completed. If any deficiencies exist, | understand that I will not receive the certificate of completion of the residency Program until all of these requirements are fulfilled. Resident signature. Date__ | 30 bani To my knowledge, the resident has completed all of the requirements of the residency- training program as defined by Nova Southeastern University College of Pharmacy PGY1 Community Pharmacy Residency Program and is granted certificate of completion of the program. ofvncs Residency Program Director Date