Please assess and mark Competent
the following domains | Competent
Wot Yet] Borderline
a 2 oO)
‘Pre=procedure
Professional | NIA
OF
Total Max (Max possible _/36):
‘Comments:Z {
[ Suggestions for development (assessor comments):
A voy ave oat — wm
m™ Ke wre porns e, wenn
Onn — om he BLN
Seifrefiecion (fo be completed by the Intern) — what did you learn from
Se eereon Cae aierenty nex tne. What stepe can you implement to anaure the next
time you perform this procedure you will do it more professionally:
gs fe th 4 paper me
I nase Pe jomt afher
te ahutuent, As wel as
Cumnuniade — ube 7 am arg
bdtey
“greed Action (intern and Assessor initial:
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