University of Vermont Nuclear Medicine Technology Program

NMT-163 Clinical Report Form

--Your Supervising Technologist-- Rocel Aguillon Christy Bowman Chelsea Bullard Emily Crook Tom DeFranco (Pharmalogic) David Gervais (CVCA) Jesse Guterres Richard Lew Steve Relation Jennifer Simpson Smith Ed Tumielewicz Jillian Turner Christin Young I also worked with: Rocel Aguillon Christy Bowman Chelsea Bullard Emily Crook Tom DeFranco (Pharmalogic) David Gervais (CVCA) Jesse Guterres Richard Lew Steve Relation Jennifer Simpson Smith Ed Tumielewicz Jillian Turner Christin Young and: Rocel Aguillon Christy Bowman Chelsea Bullard Emily Crook Tom DeFranco (Pharmalogic) David Gervais (CVCA) Jesse Guterres Richard Lew Steve Relation Jennifer Simpson Smith Ed Tumielewicz Jillian Turner Christin Young

List the procedures you observed and how many of each

SELF APPRAISAL: --During this session, I was:-- mostly observing 3/4 observing, 1/4 hands-on 1/2 observing, 1/2 hands-on 1/4 observing, 3/4 hands-on mostly hands-on --Did I arrive in clinic on time?-- YES NO --Was I prepared for this clinic session?-- YES NO --Did I adhere to the dress code?-- YES NO --Did I refrain from inappropriate conversation in front of the patient?-- YES NO N/A --Did I remain calm in a stressful situation?-- YES NO N/A --Did I accept constructive criticism from the technologist?-- YES NO N/A

--Did I communicate with patients?-- YES NO N/A --Did I make any entries in my notebook?-- YES NO --Est'd downtime during this clinic session-- 0% 25% 50% 75% 100%

If there was any "downtime", list what you did:

Give a general summary of how this clinic session went. You can also comment on any of the above selections:

OR