‘Wellness Evaluation Form Student: . Grooy Wagner CEP Site/Faculty:_ Triangle udm Weapy Please rate student performance on the following competencies using the rating system below: 3 = demonstrates entry level competence for dietitians, works independently demonstrates entry level competence for dietitians, requires occasionally assistant ‘working toward entry level competence for dietitians, requires regular assistance does not demonstrate eniry level competence for dietitians, requires routine Assistance and needs to improve knowledge base, NO =Not Observed, NA = Not Applicable Communication with Healthcare Team Time Period date 2\2_ | date 2[4 | Date 2|\ | date 2)23 Student develops rapport with health care ‘team (know role of each team member, % 2, Discusses patient issues, speaks S professionally and appropriately with others) Student participates in rounds/conferences of health care team, and other meetings (attends meetings on time, is well prepared, participates in discussion of client) w Ww Ww Ww Comments: e preceptor date preceptor date Bs 4 preceptor date preceptor date Qty Hoownluy, MS, 12D, LDN ales