Task Sheet / Dates of Rotation / ______
OBJECTIVES / OBSERVED / ASSISTED
1. Orientation to clinic
2. Locating Safety Devices
a. Emergency exits
b. Fire extinguishers
3. Standard Precautions
a. Hand washing
b. Use of PPE
4. Administrative
a. answering phones
b. booking appointments
c. greeting patients
d. obtain medical history
e. patient billing and payments (including insurance and Workman’s Comp)
f. escorting patients to and from treatment rooms
5. Health Assessment
a. vital signs
b. interview
c. nutritional status
6. Physical therapy (proper set up, use, and dismissal of patient to rooms)
a. heat / cold therapy
b. electrical stimulation
c. traction
8. Assisting in x-ray production
a. loading film
b. developing film
9. Table placement and adjustment of patient by doctor
10. Housekeeping
a. prepare room for next patient
b. wash towels and gowns
11. Other
______/ ______
Mentor Signature / Date
Community Health Agency(WIC)
/Student
/ ______Task Sheet
/Dates of Rotation
/ ______OBJECTIVES / OBSERVED / ASSISTED
1. Orientation to Community Health Center
2. Services provided by the agency
a. nutrition education classes
b. individual nutritional counseling
c. breast feeding training
d. physical exercise counseling
3. Data Collection
a. financial
b. health history
c. height, weight, hematocrit
4. Administrative tasks
a. filing
b. mailing
c. telephone / reception skills
d. data entry
e. referrals to Food Pantry
5. Outreach
a. referrals to other health care providers
b. solicitation of potential clients
c. preparation of materials
______/ ______
Mentor Signature / Date
School Nursing. / Student / ______
Task Sheet / Dates of Rotation / ______
OBJECTIVES / OBSERVED / ASSISTED
1. Orientation to clinic
2. Locating Safety Devices
a. Emergency exits
b. Fire extinguishers
3. Standard Precautions
a.. Hand washing
b. Use of PPE
4. Log in/out student name on log in sheet
5. Medical history and assessment
6. Glucometer reading and recording
7. Nutritional monitoring
8. Height and/or weight assessment
9. Check for lice
10. Wound care
a. clean wound
b. dress wound
11. Assist with sports related injuries
12. Vital signs
a. temperature
b. blood pressure
13. Testing
a. vision
b. hearing
c. scoliosis
14. Filing
15. Dispensing of prescribed and OTC medications
16. Health education lessons (in class or individual teaching)
______/ ______
Mentor’s Signature / Date
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Hospice Care / Student / ______Task Sheet / Dates of Rotation / ______
OBJECTIVES / OBSERVED / ASSISTED
1. Introduction to Long Term Care
a. handwashing
b. isolation techniques
c. communication with residents with vision loss / hearing
loss / speech problems
d. safety-ADA standards
e. residential Bill of Rights
f. Locating safety devices (emergency exits / fire extinguishers)
2. Mental Health & Social Services
a. psychosocial needs of residents
b. residents with memory loss/confusion
c. residents who are demanding/angry
d. social services counseling for resident and/or family
e. chaplain services for resident and/or family
3. Restorative Services
a. assist residents to raise head/shoulder
b. assist residents to move up in bed
c. moving the helpless resident to the HOB
d. turning resident on side
e. assist residents to sit on side of bed
f. assist residents to transfer to wheelchair
g. Range of Motion exercises (passive/active)
h. ambulation/ transporting patient
4. Diagnostic Services
a. input/output
b. vital signs
5. Therapeutic
a. oxygen treatments
b. wound care (dressing change, operative site check, and /or suture removal)
c. administration of medications
d. pain management techniques
6. Personal Care Skills
a. making the unoccupied bed
b. making the occupied bed
c. tub or shower
d. partial bath / complete bed bath
e. Perineal care female/male
f. backrub
g. brushing the teeth
h. denture care / special oral hygiene
i. special oral hygiene
j. hair care
k. shaving – electric/safety razor
l. hand and fingernail care
m. foot and toenail care
n. assisting the resident with dressing
7. Dietary
a. menu planning
b. therapeutic diets
c. food preparation (sanitation and food handling)
d. recommended daily allowances
e. substitution record
f. food disaster plan
8. Recreational therapy
a. make posters, mobiles, etc for individual activities
b. assist patients to and from activities sessions
c. encourage residents to participate in activities
d. lead activity sessions
e. interact with uninvolved residents
f. integrate music therapy into activities
______/ ______
Mentor Signature / Date
Dental Services Task Sheet / Student Name ______
Dates of Rotation ______
OBJECTIVES / OBSERVED / ASSISTED
1. Orientation to Dental Services
2. Administrative skills
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3. Routine dental visits
a. patient seating/draping
b. positioning in dental chair
c. dental charting (DMF)
d. dental radiology (FMX Panoramic)
e. oral hygiene instruction
f. dental prophylaxis
4. Infection Control
a. Standard Precautions
b. Ultrasonic cleaner
c. scrubbing instruments
d. wrapping instruments
e. sterilization monitoring
5. Operation/Care of equipment
a. light, chair, handpieces
b. oral evacuation equipment
c. dental tray set-ups
d. radiographic equipment
e. dental instruments
6. Chairside assisting
a. selection of appropriate dental tray
b. loading anesthetic syringe
c. prep of various materials
d. passing of dental instruments
e. suctioning
f. discharge instructions
7. Operative procedures
a. diagnostic impressions/models
1). preparing alginate / taking impressions
2). pouring plaster / stone models
3). trimming plaster / stone models
b. restorative
1). amalgam
2). dental composites
3). crowns
c. cosmetics
1). Bleaching
2). Veneers
d. prosthetics
1). Fixed bridges
2). Removable partial dentures
3). Full dentures
4). Implants
e. extractions
8. Safety
a. OSHA binder
b. MSDS labeling
c. infection control
9. Other
______/ ______
Mentor Signature / Date
Rehabilitation/ Sports Medicine Task Sheet
/Student
/ ______Dates of Rotation
/ ______OBJECTIVES / OBSERVED / ASSISTED
1. Orientation to Rehabilitation services
2. Routine Administrative Skills
3. Patient evaluation/assessment
a. musculoskeletal/neurological
b. mobility/ambulation/range of motion
c. patient teaching
d. prevention of disease and injury
4. Physical Therapy Treatment Modalities
a. traction
b. hot packs/cryotherapy
c. ultrasound
d. massage
e. electrical stimulation
5. Gait training crutches/walker/cane
6. Therapeutic Exercises
a. strengthening/coordination
b. ADL
c. endurance/coordination
d. stretching
e. dynomometer
f. balance-neuromuscular
6. Standard Precautions
______/ ______
Mentor Signature / Date
Podiatry
/Student
/ ______Task Sheet
/Dates of Rotation
/ ______OBJECTIVES / OBSERVED / ASSISTED
1. Orientation to Podiatry Services
2. Infection Control
a. standard precautions
b. cleaning of rooms
c. processing of instruments
d. disposal of sharps
3. Safety
a. OSHA binder
b. MSDS labeling
4. Health Assessment/Treatment
a. vital signs
b. interview
1. chief complaint/reason for visit
2. health history(including allergies & medications)
c.x-ray exposure
d. x-ray processing
e. minor surgery
f. casting for orthotics
5. Administrative
a. assembling charts
b. analyzing records for completion
6. Communication skills
a. telephone techniques
b. taking and recording messages
c. prescription call ins
d. referrals
e. escorting patients to and from rooms
7. Care of Equipment
a. film developer
b. other equipment
8. Follow-up visits
a.post op/ post treatment
b.misc. care
9. Other
______/ ______
Mentor Signature / Date
Orthodontics Task Sheet / Student______
Dates of Rotation ______
OBJECTIVES / OBSERVED / ASSISTED
1. Dental administrative skills
2. Patient assisting
a. patient seating/draping
b. positioning in dental chair
c. charting
d. discharge instructions
3. Infection control
a. Standard Precautions
b. Ultrasonic cleaner
c. scrubbing instruments
d. wrapping instruments
e. autoclaving instrument packs
4. Diagnostic tools
a. Radiographic (Cephalometric & Panorex)
b. Alginate impression
c. Pouring stone models
5. Oral hygiene instructions
a. Brushing and flossing
b. Spacers and braces
6. Chairside Assisting
a. separators
b. brackets and molar bands
c. change elastomeric ties and archwires
d. coil springs and power chain
e. retainers
7. Equipment
a. dental light, chair, handpiece
b. Evacuator, air-water syringe
c. Curing light
8. Instruments
a. Mirror
b. Lip retractors
c. Cotton pliers
d. Hemostat
e. Scaler
f. Explorer
g. Spatula
9. Pliers
a. Endcutting pliers
b. Pointed beak pliers
c. Wire bending pliers
d. Coon pliers
e. Band seater with square tip
f. Bracket removing pliers
g. Side cutting pliers
h. Weingart pliers
i. Separating pliers
10. Safety
a. OSHA binder
b. MSDS labeling
c. Infection control
______/ ______
Mentor Signature / Date
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Pharmacy / Student / ______Task Sheet / Dates of Rotation / ______
OBJECTIVES / OBSERVED / ASSISTED
1. Orientation to Pharmacy
2. Procedures
a. Charging/billing/credit
b. use of pharmacy profile/dispensing machine
c. Inventory
d. Reconciliation
e. Narcotic tracking methods
3. Filling Medication Orders
a. accuracy quality checks
b. dosage calculation
c. medication order
d. medication distribution
e. Generic vs. Brand name medications
4. Demonstrate aseptic hand washing technique
5. Compounding Procedures
a. use of balance
b. use of mortar and pestle
c. selection of proper measuring for liquids and powders
d. compounding techniques
1) capsules
2) ointments
3) suppositories
4) oral syringes
5) flavorings
9. Patient teaching/education
10. Information resources such as PDR
______/ ______
Mentor Signature / Date
Bottom of Form 0
Recreational Therapy / Student / ______Task Sheet / Dates of Rotation / ______
OBJECTIVES / OBSERVED / ASSISTED
1. Orientation to Recreational Therapy
2. Develop and post activities on calendar
3. Make posters/mobiles/newsletters for individual activities
4. Assist residents to and from activities sessions
5. Encourage residents to participate in activities
6. Lead activity sessions
7. Interact with uninvolved residents
8. Integrate music therapy into activities
9. Distribute activity calendars and newsletters
10. Distribute mail to residents
11. Assist in reading mail to residents
12. Prepare mail for residents
______/ ______
Mentor Signature / Date
Skilled Nursing / Student / ______
Task Sheet / Dates of Rotation / ______
OBJECTIVES / OBSERVED / ASSISTED
1. Orientation to SNU
2. Locating Safety Devices
a. Emergency exits
b. Fire extinguishers
3. Standard Precautions
a. Hand washing
b. Isolation techniques
4. Answering call lights / signals
5. AM Care
a. bathing, dressing patients
b. nourishments
c. changing bed linens
d. intake & output
e. vital signs
6. Wound Care
a. dressing change
b. operative site check
c. suture removal
7. Ambulation / transporting patients
8. Admission/discharge procedures
______/ ______
Mentor Signature / Date
Bottom of Form 0
Gerontology / Student / ______Task Sheet / Dates of Rotation / ______
OBJECTIVES / OBSERVED / ASSISTED
1. Introduction to Long Term Care
a. handwashing
b. communication with residents with vision loss / hearing
loss / speech problems
c. safety
2. Mental Health & Social Services
a. psychosocial needs of residents
b. residents with memory loss/confusion
c. residents who are demanding/angry
3. Restorative Services
a. assist residents to raise head/shoulder
b. assist residents to move up in bed
c. moving the helpless resident to the HOB
d. turning resident on side
e. assist residents to sit on side of bed
f. assist residents to transfer to wheelchair
g. Range of Motion exercises
4. Personal Care Skills
a. making the unoccupied bed with permission
b. making the occupied bed with permission
c. tub or shower with permission
d. partial bath / complete bed bath with permission
e. Perineal care female/male
f. backrub
g. brushing the teeth
h. denture care / special oral hygiene
i. special oral hygiene
j. hair care
k. shaving – electric/safety razor
l. hand and fingernail care
m. foot and toenail care
n. assisting the resident with dressing
______/ ______
Mentor Signature / Date
Bottom of Form 0
Bottom of Form 0
Medical Laboratory
/Student
/ ______Task Sheet
/Dates of Rotation
/ ______OBJECTIVES / OBSERVED / ASSISTED
1. Orientation to clinical laboratory
2. Safety in the department
a. Infection control
b. Fire safety
3. Specimen Collection/Processing
a. types of specimens
b. supplies/equipment/techniques
4. Hematology Procedures
a. manual WBC, RBC, platelet count
b. blood smear preparation
c. cell ID and differentiation
d. coagulation studies
5. Chemistry Procedures
a. routine chemistry tests
b. drug assays
c. isoenzymes
d. immunoassays
e. electrophoresis
6. Blood Bank
a. ABO and Rh blood group systems
b. antiglobulin testing
c. compatibility testing
d. hemolytic diseases
e. blood preparation/storage
7. Microbiology
a. culture inoculation
b. Gram stain preparation/procedure
8. Urinalysis/Serology Procedures
a. chemical analysis
b. microscopic exam of sediment
c. qualitative serological tests
9. Phlebotomy Skills
a. specimen collection type ______
b. patient ID, labeling, logging
______/ ______
Mentor Signature / Date
Emergency Services
/Student
/ ______Task Sheet
/Dates of Rotation
/ ______OBJECTIVES / OBSERVED / ASSISTED
1. Orientation to Emergency Department
2. Standard Precautions
3. Triage
a. assessment
b. vital signs
4. Treatments
a. orthopedic injuries: observed
b. pediatric conditions: observed
c. lacerations, Tx
d. cardiac conditions, condition observed
12 lead EKG
e. respiratory distress
1. respiratory assessment
2. O2 sat monitoring
3. nebulizer tx
4. use of cannula
5. use of ambu bag
6. intebation techniques
f. head/neck injuries
g. allergic reactions, Tx
h. medical conditions, condition observed
5. Acute care
a. trauma
b. cardiac/respiratory arrest
6. Special Procedures
a. EENT
b. Radiography
c. Laboratory
7. Patient transport
8. Discharge or Admission
______/ ______
Mentor Signature / Date
Radiology / Student / ______
Task Sheet / Dates of Rotation / ______
OBJECTIVES / OBSERVED / ASSISTED
1. Orientation to Diagnostics
2. Method of processing film
a. developing/darkroom process
b. digital radiography
c. identifying film
d. storing/filing/retrieval of films
3. Radiographic positioning
a.. upper/lower extremities
b. chest/abdomen
c. vertebral column/skull
4. Special / Special studies
a. cholecystogram
b. intravenous pyelogram
c. angiography
d. mammography
e. ultrasonography
5. Radiation safety and protection
a. lead aprons
b. radiation monitoring (badges/dosimeters)
6. Transporting patients
7. Other (please state)
______/ ______
Mentor Signature / Date
Bottom of Form 0
Optometry / Student / ______Task Sheet / Dates of Rotation / ______
OBJECTIVES / OBSERVED / ASSISTED
1. Orientation to Ophthalmology
2. Assessment
a. Glaucoma exam
b Vision exam
c. Cataract exam
d. Eye pressure exam
e. Vision field test – Humphrey / Goldman
f. Slit lamp exam
g. External exam
h. Refractions
i. Complete eye exam
j. Fundus exam
3. Administrative
a. Charting
b. Computer record keeping
c. Checking patients in and out
4. Equipment
a. Lensometer
b. Snellen Chart
c. Ophthalmoscope – direct / indirect
d. Slit lamp
e. Tonometer
f. Retinoscope
g. Phoroptor
5. Other
______/ ______
Mentor Signature / Date
Opticianry / Student / ______
Task Sheet / Dates of Rotation / ______
OBJECTIVES / OBSERVED / ASSISTED
1. Orientation to Opticianry
2. Lens Terms and Classification
3. Light and Light Refraction
4. Using Measuring Instruments
5. Lens Prescriptions and Calculations
6. Lens Production
7. Eyeglass Assembly, Alignment, Quality Control
8. Owning an Optical Business
9. Eye Functions and Deficiencies
10. Human Relations in Business Ownership
11. Other
______/ ______
Mentor Signature / Date
Bottom of Form 0
Day Habitation Program / Student / ______Task Sheet / Dates of Rotation / ______
OBJECTIVES / OBSERVED / ASSISTED
1. Orientation to Day Habitation Program
2. Develop and post activities on calendar
3. Make posters/mobiles/newsletters for individual activities
4. Assist consumers to and from activities sessions
5. Encourage consumers to participate in activities
6. Lead activity sessions
7. Interact with uninvolved consumers
8. Integrate music therapy into activities
9. Distribute activity calendars and newsletters
10. Assist with filing and administrative duties
11. Assist consumers with reading and writing.
12. Assist with cleaning the facility.
13. Other
______/ ______
Mentor Signature / Date
County Health Department
/Student
/ ______Task Sheet
/Dates of Rotation
/ ______OBJECTIVES / OBSERVED / ASSISTED
1. Orientation to Occupational Health Services
2. Infection Control
a. standard precautions
b. cleaning of rooms
d. disposal of sharps
3. Health Assessment/Treatment
a. interview
1. reason for visit
2. health history(including allergies & medications)
4. Administrative
a. assembling charts
b. analyzing records for completion
5. Communication skills
a. telephone techniques
b. taking and recording messages
d. referrals
6. Immunizations
a. secure parental permission if needed
b. educate patient as needed
c. administer necessary immunization using standard precautions
d. give follow-up instructions and precautions
7. Follow-up visits- assess for next visit
8. Other
______/ ______
Mentor Signature / Date
Small Animal Veterinary / Student / ______
Task Sheet / Dates of Rotation / ______
OBJECTIVES / OBSERVED / ASSISTED
1. Orientation to clinic
2. Routine Administrative Skills
a. answering phone
b. making appointments
c. collecting appointment fees
3. Routine Physical examinations/immunizations
4. Professional Skills
a. caring for animals
b. restraining animals
c. vital signs
d. use of x-ray equipment
e. use of surgical instruments
f. surgical preparation
g. surgical procedures
h. assistance at births
i. euthanasia techniques
5. Laboratory examinations
a. fecal / blood examinations
b. bacteriological tests
c. urinalysis
6. Clinical signs of common diseases
a. bacterial/ fungal / viral
b. nutritional diseases
7. Sterilization and disinfection procedures
a. use of autoclave
b. chemical asepsis
c. ultrasonic cleaning
d. sterile technique
______/ ______
Mentor Signature
Date
Bottom of Form 0
Large Animal Veterinary Medicine / Student / ______Task Sheet / Dates of Rotation / ______
OBJECTIVES / OBSERVED / ASSISTED
1. Orientation to clinic
2. Routine Administrative Skills
a. answering phone
b. making appointments
c. completing charts
d. collecting appointment fees
3. Routine Physical examinations/immunizations
a. teeth float
b. vaccinations
c. worming
d. other (please state)
4. Professional Skills
a. animal nutrition
b. restraining animals
c. vital signs
d. use of x-ray equipment
e. use of surgical instruments
f. surgical preparation
g. surgical procedures
h. assistance at births
i. euthanasia techniques
5. Laboratory examinations
a. fecal / blood examinations
b. bacteriological tests
c. urinalysis
6. Clinical signs of common diseases
a. bacterial/ fungal / viral
b. nutritional diseases
7. Cattle and/or Horse Procedures
a. palpation
b. dehorning
c. artificial insemination
Emergency procedures
a. colic treatment
b. lacerations
c. lameness
8. Sterilization and disinfection procedures
a. use of autoclave
b. chemical asepsis
c. ultrasonic cleaning
9. Stall management
______/ ______
Mentor Signature
Date
Life Skills / Student / ______
Task Sheet / Dates of Rotation / ______
OBJECTIVES / OBSERVED / ASSISTED
1. Orientation to Day Habitation Program
2. Develop and post activities on calendar
3. Lead learning activities
4. Assist students to and from activities sessions
5. Encourage students to participate in activities
6. Lead physical activity sessions
7. Interact with uninvolved students
8. Integrate music therapy into activities
9. Distribute learning materials
10. File and assist with administrative duties
11. Assist students with reading and writing.
12. Observe/ assist with special health care procedures
13. Assist with cleaning the facility.
14. Other
______/ ______
Mentor Signature / Date
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