2012
Community Pharmacy
PERSONAL PARTICULARS
(TO BE COMPLETED BY PROVISIONALLY REGISTERED
PHARMACIST PRP)
1.
2.
I/C Number :
3.
4.
Telephone Number:
5.
6.
Home Address :
7.
8.
E-mail Address :
9.
10.
Scholarship/Sponsor Federal/MARA/PTPTN/Others) :
11.
12.
Commencement Date:
13.
Signature :
Date :
Name :
Page 2
Community Pharmacy
1. INTRODUCTION
1.1
1.2
1.3
The PBM may extend for not more than one year the period of
training of a provisionally registered pharmacist (PRP) if the Board is
not satisfied with the performance of that person as a pharmacist.
1.4
1.5
Page 3
Community Pharmacy
2.1
2.2
This record book will be the basis for the appraisal by all preceptors,
which will be submitted to the PBM for the purpose of registration as a
Fully Registered Pharmacist (FRP).
2.3
2.4
2.5
Private Hospital
Industrial Pharmacy (manufacturing)
Research and Development (teaching institution)
Community Pharmacy
2.4.2
2.4.3
Page 4
Community Pharmacy
The passing mark is 60 % for each respective section and the sum
total of all the sections.
2.5.3 The final appraisal is to be completed by the Master Preceptor at
the 11th month of the training period and to be sent to ;
Setiausaha
Lembaga Farmasi Malaysia
Bahagian Perkhidmatan Farmasi
Kementerian Kesihatan Malaysia
Lot 36, Jalan Universiti,
46350 PETALING JAYA
Page 5
Community Pharmacy
3.1
CRITERIA OF A PRECEPTOR
Not less than four years of experience as a registered practising pharmacist
in Malaysia.
3.2
Responsibilities of a Preceptor;
3.2.1 To be a learning resource for the PRP who receives necessary training
to develop skills and competencies as a community pharmacist.
3.2.2 To guide the PRP throughout 52 weeks of training.
3.2.3 To be a role model as a professional pharmacist to the PRP
3.2.4 To provide professional services and constructive feedbacks during the
training.
3.2.5 To assess PRP performances during the training period.
Page 6
Community Pharmacy
4.
At all-times comply with the directives and orders given to you by the
department head.
4.2
4.3
4.4
4.5
Recognize that not all of the preceptors time can be devoted to teaching, and
you should therefore actively acquire knowledge and skills by observation,
reading and questioning others.
4.6
Be aware that, in addition to the daily activities, your time should be set aside to
consider activities outside working/office hours.
4.7
4.8
(ii)
training
Page 7
Community Pharmacy
4.9
Duration
(Weeks)
TOTAL
8-12
52
Page 8
Community Pharmacy
ASSESSMENT
Page 9
Community Pharmacy
1.
1.1
No.
Knowledge
Level of Performance
1
Understanding of the
Relevant Legislations
1.1
Local Government
Licensing, Practicing
Licensing, Business
Components
Comments
NA
Page 10
Community Pharmacy
1.2
FINANCIAL MANAGEMENT
Knowledge
Level of Performance
1
1.
1.3
Comments
NA
Understanding of Profit
Loss Analysis, Performance
measurements and financial
control.
Knowledge
Level of Performance
1
1.
2.
Comments
NA
Page 11
Community Pharmacy
No.
Task
Level of Performance
1
3.
1.4
Comments
NA
To perform product
merchandising for min of 20
items
No.
Knowledge
Level of Performance
1
1.
Comments
NA
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Community Pharmacy
1.5
SAFETY
No.
Knowledge
Level of Performance
1
1.
1.6
Comments
NA
Understanding on the
relevant safety aspects and
statutory requirements
CUSTOMER SERVICE
Understanding that customer satisfaction is a major requisite to business success.
No.
Knowledge
Level of Performance
1
1.
Comments
NA
Understanding of client
satisfaction.
Page 13
Community Pharmacy
1.7
(Minimum of 10 cases)
Level of Performance
No.
1
Task
Comments
NA
______________ %
40
Preceptors Name & Signature:
NOTE:
1. If the service is not available in the industry, the Principal Preceptor/ Head of Pharmacists in the organisation
therefore has right to transfer the PRP to other units/ sections.
2. % mark should not less than 60% for every units/ sections.
Page 14
Community Pharmacy
2.0
Page 15
Community Pharmacy
8. Proficient in dispensing.
9. Knowledge on the pre-packing process, packaging and labeling of medication dispensed.
Page 16
Community Pharmacy
SECTION 1:
SCREENING
WEEK 1
Type of Interventions
Date
Incomplete
Prescriptions
Inappropriate
Regimens
Inappropriate
Prescriptions
Other
Point of
Screening
(*R/F/D)
Description of intervention(s)
Type of Interventions:
1.
2.
3.
4.
Incomplete Prescriptions
Inappropriate Regimens
Inappropriate Prescriptions
Other
* R: Receiving
Name of Preceptor:
Signature:
D: Dispensing
General Remarks:
Page 17
Community Pharmacy
SECTION 1:
SCREENING
WEEK 2
Type of Interventions
Date
Incomplete
Prescriptions
Inappropriate
Regimens
Inappropriate
Prescriptions
Other
Point of
Screening
(*R/F/D)
Description of intervention(s)
Type of Interventions:
1.
2.
3.
4.
Incomplete Prescriptions
Inappropriate Regimens
Inappropriate Prescriptions
Other
* R: Receiving
Name of Preceptor:
Signature:
D: Dispensing
General Remarks:
Page 18
Community Pharmacy
SECTION 1:
SCREENING
WEEK 3
Type of Interventions
Date
Incomplete
Prescriptions
Inappropriate
Regimens
Inappropriate
Prescriptions
Other
Point of
Screening
(*R/F/D)
Description of intervention(s)
Type of Interventions:
1.
2.
3.
4.
Incomplete Prescriptions
Inappropriate Regimens
Inappropriate Prescriptions
Other
* R: Receiving
Name of Preceptor:
Signature:
D: Dispensing
General Remarks:
Page 19
Community Pharmacy
SECTION 1:
SCREENING
WEEK 4
Type of Interventions
Date
Incomplete
Prescriptions
Inappropriate
Regimens
Inappropriate
Prescriptions
Other
Point of
Screening
(*R/F/D)
Description of intervention(s)
Type of Interventions:
1.
2.
3.
4.
Incomplete Prescriptions
Inappropriate Regimens
Inappropriate Prescriptions
Other
* R: Receiving
Name of Preceptor:
(a) Frequency
(b) Duration
(a) Medicine
(b) Duration
(a) Spelling
(b) Wrong Identification
(a) Not in the hospital drug formulary
F: Filling
Signature:
(d) Countersignature
(d) Frequency
(d) Interaction (e) Contraindication
(c) Illegibility
D: Dispensing
General Remarks:
Page 20
Community Pharmacy
SECTION 1:
SCREENING
WEEK 5
Type of Interventions
Date
Incomplete
Prescriptions
Inappropriate
Regimens
Inappropriate
Prescriptions
Other
Point of
Screening
(*R/F/D)
Description of intervention(s)
Type of Interventions:
1.
2.
3.
4.
Incomplete Prescriptions
Inappropriate Regimens
Inappropriate Prescriptions
Other
* R: Receiving
Name of Preceptor:
(a) Frequency
(b) Duration
(a) Medicine
(b) Duration
(a) Spelling
(b) Wrong Identification
(a) Not in the hospital drug formulary
F: Filling
Signature:
(d) Countersignature
(d) Frequency
(d) Interaction (e) Contraindication
(c) Illegibility
D: Dispensing
General Remarks:
Page 21
Community Pharmacy
SECTION 1:
SCREENING
WEEK 6
Type of Interventions
Date
Incomplete
Prescriptions
Inappropriate
Regimens
Inappropriate
Prescriptions
Other
Point of
Screening
(*R/F/D)
Description of intervention(s)
Type of Interventions:
1.
2.
3.
4.
Incomplete Prescriptions
Inappropriate Regimens
Inappropriate Prescriptions
Other
* R: Receiving
Name of Preceptor:
(a) Frequency
(b) Duration
(a) Medicine
(b) Duration
(a) Spelling
(b) Wrong Identification
(a) Not in the hospital drug formulary
F: Filling
Signature:
(d) Countersignature
(d) Frequency
(d) Interaction (e) Contraindication
(c) Illegibility
D: Dispensing
General Remarks:
Page 22
Community Pharmacy
SECTION 1:
SCREENING
WEEK 7
Type of Interventions
Date
Incomplete
Prescriptions
Inappropriate
Regimens
Inappropriate
Prescriptions
Other
Point of
Screening
(*R/F/D)
Description of intervention(s)
Type of Interventions:
1.
2.
3.
4.
Incomplete Prescriptions
Inappropriate Regimens
Inappropriate Prescriptions
Other
* R: Receiving
Name of Preceptor:
(a) Frequency
(b) Duration
(a) Medicine
(b) Duration
(a) Spelling
(b) Wrong Identification
(a) Not in the hospital drug formulary
F: Filling
Signature:
(d) Countersignature
(d) Frequency
(d) Interaction (e) Contraindication
(c) Illegibility
D: Dispensing
General Remarks:
Page 23
Community Pharmacy
SECTION 1:
SCREENING
WEEK 8
Type of Interventions
Date
Incomplete
Prescriptions
Inappropriate
Regimens
Inappropriate
Prescriptions
Other
Point of
Screening
(*R/F/D)
Description of intervention(s)
Type of Interventions:
1.
2.
3.
4.
Incomplete Prescriptions
Inappropriate Regimens
Inappropriate Prescriptions
Other
* R: Receiving
Name of Preceptor:
(a) Frequency
(b) Duration
(a) Medicine
(b) Duration
(a) Spelling
(b) Wrong Identification
(a) Not in the hospital drug formulary
F: Filling
Signature:
(d) Countersignature
(d) Frequency
(d) Interaction (e) Contraindication
(c) Illegibility
D: Dispensing
General Remarks:
Page 24
Community Pharmacy
SECTION 1: SCREENING
WEEK 9
Type of Interventions
Date
Incomplete
Prescriptions
Inappropriate
Regimens
Inappropriate
Prescriptions
Other
Point of
Screening
(*R/F/D)
Description of intervention(s)
Type of Interventions:
1.
2.
3.
4.
Incomplete Prescriptions
Inappropriate Regimens
Inappropriate Prescriptions
Other
* R: Receiving
Name of Preceptor:
(a) Frequency
(b) Duration
(a) Medicine
(b) Duration
(a) Spelling
(b) Wrong Identification
(a) Not in the hospital drug formulary
F: Filling
Signature:
(d) Countersignature
(d) Frequency
(d) Interaction (e) Contraindication
(c) Illegibility
D: Dispensing
General Remarks:
Page 25
Community Pharmacy
SECTION 1:
SCREENING
WEEK 10
Type of Interventions
Date
Incomplete
Prescriptions
Inappropriate
Regimens
Inappropriate
Prescriptions
Other
Point of
Screening
(*R/F/D)
Description of intervention(s)
Type of Interventions:
1.
2.
3.
4.
Incomplete Prescriptions
Inappropriate Regimens
Inappropriate Prescriptions
Other
* R: Receiving
Name of Preceptor:
(a) Frequency
(b) Duration
(a) Medicine
(b) Duration
(a) Spelling
(b) Wrong Identification
(a) Not in the hospital drug formulary
F: Filling
Signature:
(d) Countersignature
(d) Frequency
(d) Interaction (e) Contraindication
(c) Illegibility
D: Dispensing
General Remarks:
Page 26
Community Pharmacy
SECTION 1:
SCREENING
WEEK 11
Type of Interventions
Date
Incomplete
Prescriptions
Inappropriate
Regimens
Inappropriate
Prescriptions
Other
Point of
Screening
(*R/F/D)
Description of intervention(s)
Type of Interventions:
1.
2.
3.
4.
Incomplete Prescriptions
Inappropriate Regimens
Inappropriate Prescriptions
Other
* R: Receiving
Name of Preceptor:
(a) Frequency
(b) Duration
(a) Medicine
(b) Duration
(a) Spelling
(b) Wrong Identification
(a) Not in the hospital drug formulary
F: Filling
Signature:
(d) Countersignature
(d) Frequency
(d) Interaction (e) Contraindication
(c) Illegibility
D: Dispensing
General Remarks:
Page 27
Community Pharmacy
SECTION 1:
SCREENING
WEEK 12
Type of Interventions
Date
Incomplete
Prescriptions
Inappropriate
Regimens
Inappropriate
Prescriptions
Other
Point of
Screening
(*R/F/D)
Description of intervention(s)
Type of Interventions:
1.
2.
3.
4.
Incomplete Prescriptions
Inappropriate Regimens
Inappropriate Prescriptions
Other
* R: Receiving
Name of Preceptor:
(a) Frequency
(b) Duration
(a) Medicine
(b) Duration
(a) Spelling
(b) Wrong Identification
(a) Not in the hospital drug formulary
F: Filling
Signature:
(d) Countersignature
(d) Frequency
(d) Interaction (e) Contraindication
(c) Illegibility
D: Dispensing
General Remarks:
Page 28
Community Pharmacy
SECTION 2:
Date of
assessment
Patient Particulars
Remarks
Page 29
Community Pharmacy
SECTION 3:
Date
Page 30
Community Pharmacy
SECTION 3:
Date
Page 31
Community Pharmacy
MEDICATION COUNSELING
SECTION 4
(Minimum of 50 cases)
Date
Name of
Patient
Type of
Ailments
Action
Taken
Advice
Given
Comments
Page 32
Name &
Signature of
Preceptor
Community Pharmacy
SECTION 4:
WEEK 1
Counseling Based On The Types Of Pharmacotherapy Management
minimum 5 patients/ type *where applicable
Date
Patients
RN
Anti
diabetics
Anti
hypertensives
Anti
Asthmatics
Anti
Retrovirals
Page 33
Anti
coagulants
Others
(Please
Specify)
Name &
Signature
of
Preceptor
Community Pharmacy
SECTION 4:
WEEK 2
Counseling Based On The Types Of Pharmacotherapy Management
minimum 5 patients/ type *where applicable
Date
Patients
RN
Anti
diabetics
Anti
hypertensives
Anti
Asthmatics
Anti
Retrovirals
Page 34
Anti
coagulants
Others
(Please
Specify)
Name &
Signature
of
Preceptor
Community Pharmacy
SECTION 4:
WEEK 3
Counseling Based On The Types Of Pharmacotherapy Management
minimum 5 patients/ type *where applicable
Date
Patients
RN
Anti
diabetics
Anti
hypertensives
Anti
Asthmatics
Anti
Retrovirals
Page 35
Anti
coagulants
Others
(Please
Specify)
Name &
Signature
of
Preceptor
Community Pharmacy
SECTION 4:
WEEK 4
Counseling Based On The Types Of Pharmacotherapy Management
minimum 5 patients/ type *where applicable
Date
Patients
RN
Anti
diabetics
Anti
hypertensives
Anti
Asthmatics
Anti
Retrovirals
Page 36
Anti
coagulants
Others
(Please
Specify)
Name &
Signature
of
Preceptor
Community Pharmacy
SECTION 4:
WEEK 5
Counseling Based On The Types Of Pharmacotherapy Management
minimum 5 patients/ type *where applicable
Date
Patients
RN
Anti
diabetics
Anti
hypertensives
Anti
Asthmatics
Anti
Retrovirals
Page 37
Anti
coagulants
Others
(Please
Specify)
Name &
Signature
of
Preceptor
Community Pharmacy
SECTION 4:
WEEK 6
Counseling Based On The Types Of Pharmacotherapy Management
minimum 5 patients/ type *where applicable
Date
Patients
RN
Anti
diabetics
Anti
hypertensives
Anti
Asthmatics
Anti
Retrovirals
Page 38
Anti
coagulants
Others
(Please
Specify)
Name &
Signature
of
Preceptor
Community Pharmacy
SECTION 4:
WEEK 7
Counseling Based On The Types Of Pharmacotherapy Management
minimum 5 patients/ type *where applicable
Date
Patients
RN
Anti
diabetics
Anti
hypertensives
Anti
Asthmatics
Anti
Retrovirals
Page 39
Anti
coagulants
Others
(Please
Specify)
Name &
Signature
of
Preceptor
Community Pharmacy
SECTION 4:
WEEK 8
Counseling Based On The Types Of Pharmacotherapy Management
minimum 5 patients/ type *where applicable
Date
Patients
RN
Anti
diabetics
Anti
hypertensives
Anti
Asthmatics
Anti
Retrovirals
Page 40
Anti
coagulants
Others
(Please
Specify)
Name &
Signature
of
Preceptor
Community Pharmacy
SECTION 4:
WEEK 9
Counseling Based On The Types Of Pharmacotherapy Management
minimum 5 patients/ type *where applicable
Date
Patients
RN
Anti
diabetics
Anti
hypertensives
Anti
Asthmatics
Anti
Retrovirals
Page 41
Anti
Coagulants
Others
(Please
Specify)
Name &
Signature
of
Preceptor
Community Pharmacy
SECTION 4:
WEEK 10
Counseling Based On The Types Of Pharmacotherapy Management
minimum 5 patients/ type *where applicable
Date
Patients
RN
Anti
diabetics
Anti
hypertensives
Anti
Asthmatics
Anti
Retrovirals
Page 42
Anti
coagulants
Others
(Please
Specify)
Name &
Signature
of
Preceptor
Community Pharmacy
SECTION 4:
WEEK 11
Counseling Based On The Types Of Pharmacotherapy Management
minimum 5 patients/ type *where applicable
Date
Patients
RN
Anti
diabetics
Anti
hypertensives
Anti
Asthmatics
Anti
Retrovirals
Page 43
Anti
coagulants
Others
(Please
Specify)
Name &
Signature
of
Preceptor
Community Pharmacy
SECTION 4:
WEEK 12
Counseling Based On The Types Of Pharmacotherapy Management
minimum 5 patients/ type *where applicable
Date
Patients
RN
Anti
diabetics
Anti
hypertensives
Anti
Asthmatics
Anti
Retrovirals
Page 44
Anti
coagulants
Others
(Please
Specify)
Name &
Signature
of
Preceptor
Community Pharmacy
SECTION 5:
Date
Number of
Counseling Sessions
Antidiabetics
Antihypertensives
Antiasthmatics
Page 45
Name &
Signature of
Preceptor
Community Pharmacy
SECTION 6:
Date
Page 46
Community Pharmacy
Extemporaneous Preparations
Date
MRN
Name of Preparation
Remarks
Page 47
Signature of
Preceptor
Community Pharmacy
ASSESSMENT
SECTION 8:
No.
Knowledge
Comments
1
Page 48
NA
Community Pharmacy
SECTION 9:
COMPETENT ASSESSMENT
Level of Performance
No.
Task
Screening
Filling of Prescriptions
Dispensing
Medication Counseling
Job
Page 49
NA
Comments
Community Pharmacy
Mark
______________ x 100%
52
______________ %
NOTE:
1. If the service is not available in the hospital, the Principal Preceptor/ Head of Pharmacists in the hospital (KPF)
therefore has right to disseminate the PRP to other unit/ service.
2. % mark should not less than 60% for every units/ services.
Page 50
Community Pharmacy
Task
Level of Performance
1
ORGANIZATION
CHART
NA
STRUCTURE/LAYOUT/
Page 51
Comments
Name and
Signature of
Preceptor
Community Pharmacy
Date
Task
Level of Performance
1
NA
TREASURY INSTRUCTION
Able to recognize the different
method/processes in procurement:
Direct purchase
Quotation
Bin card
Computerised Inventory program
Page 52
Comments
Name and
Signature of
Preceptor
Community Pharmacy
Task
Level of Performance
1
NA
Ordering systems
Page 53
Comments
Name and
Signature of
Preceptor
Community Pharmacy
Date
Task
Level of Performance
1
NA
Receiving Of Goods
Stock checking against Inv or D/O against P/O
Expiry date checking
Sign and acknowledgement on D/O & Inv
At least 10 exercise of the above event
Applicable only to Preceptor with
wholesaling activity
Include Good Distribution Practice (GDP)
Working knowledge with respect to the
legislative requirement on wholesaling activity.
(e.g. the recording requirement, licensing
requirement,)
Page 54
Comments
Name and
Signature of
Preceptor
Community Pharmacy
3.2
STORAGE
Task
Level of Performance
1
NA
Min 10 items
Page 55
Comments
Name and
Signature of
Preceptor
Community Pharmacy
3.3
INVENTORY CONTROL
Knowledge and understanding of drug usage patterns, identification of slow and non-moving stocks, maximum and
minimum stock levels, cost accounting, and expiry date monitoring
Date
Task
Level of Performance
1
NA
Page 56
Comments
Name and
Signature of
Preceptor
Community Pharmacy
Date
Task
Level of Performance
1
NA
Return procedure
Familiar with the method to initiate and
complete return procedure (generate Trade
Return Notes / Goods Return Notes or ask for
Credit Note)
e.g.: Wrong item sent, near expiry goods
received
Min 5 incidences
Page 57
Comments
Name and
Signature of
Preceptor
Community Pharmacy
3.4 DISPOSAL
Knowledge of disposal procedures and documentation.
Date
Task
Level of Performance
1
NA
DISPOSAL PROCESS
Able to understand the workflow for proper
disposal
Page 58
Comments
Name and
Signature of
Preceptor
Community Pharmacy
Date
Task
Level of Performance
1
NA
Page 59
Comments
Name and
Signature of
Preceptor
Community Pharmacy
Date
Task
Level of Performance
1
NA
Page 60
Comments
Name and
Signature of
Preceptor
Community Pharmacy
3.7
Knowledge of psychotropic and dangerous drugs distribution and disposal in accordance to the respective legislations
Date
Task
Level of Performance
1
NA
Page 61
Comments
Name and
Signature of
Preceptor
Community Pharmacy
4.
No.
Level of Performance
1
1.
Comments
Preceptor
NA
Handling of Medication
Error Reporting and
Adverse Drug Reaction
Reporting
Medication Safety Centre,
Ministry of Health
(minimum 2 cases-if any)
e.g Filling up MADRAC
form. Malaysian Adverse
Drug Reaction Advisory
Committee
Page 62
Community Pharmacy
Mark
______________ x 100%
104
______________ %
NOTE:
3. If the service is not available in the hospital, the Principal Preceptor/ Head of Pharmacists in the hospital (KPF)
therefore has right to disseminate the PRP to other unit/ service.
4. % mark should not less than 60% for every units/ services.
Page 63
Community Pharmacy
Examples of activities
Week 1 week 26
Orientation
Company Policies
References
Extemporaneous Prep , SOP
Dispensing Guidelines
Near Misses
Topics of Minor ailments
Working relationship with staff
Security/ safety
CPD
Extended services : methadone
Counselling technique
Poison classification
Medical services
Company business activities
Drug interactions
OTC
Infection diseases
Cough
Health promotion activities
TCM
Rapport / communication with prescribers
Storage of eye /ear drops
Referrals
Stock management / expiry
ADR/ Medication errors
Address out-of-stock situation
Page 64
Community Pharmacy
Page 65
Community Pharmacy
Page 66
Community Pharmacy
Photo (to be
affixed here)
I/C Number: .
PRP Registration Number: ..
Place of Training: ..
I certify that the above PRP has completed his/ her training as required under subsection 6A
(2) of the Registration of Pharmacists Act 1951.
1. Proposal:
1A. The above PRP has obtained average mark of: __________ % and
1B. He/ She has *passed/ failed the Pharmacy Jurisprudence Examination
in Unit/Section ________________________________
*He/
She
Examination
needs
to
pass
the
Pharmacy
*or/and
Jurisprudence
Page 67
Community Pharmacy
2.1 Name:
2.2 Office address:
2.3
2.4 Date:
Page 68
Community Pharmacy
Setiausaha
Lembaga Farmasi Malaysia
Bahagian Perkhidmatan Farmasi
Kementerian Kesihatan Malaysia
Beg Berkunci No.924
Pejabat Pos Jalan Sultan
46790 PETALING JAYA
PROPOSAL OF FULL REGISTRATION
Name of Provisionally Registered Pharmacist [PRP]: .
I/C Number:
PRP Registration Number: .
Place of Training:
I certify that the above PRP has completed his/ her training as required under
subsection 6A (2) of the Registration of Pharmacists Act 1951.
1. Proposal:
1A. Certificate of satisfactory experience in accordance to sub-regulation 7(1)
Registration of Pharmacists Regulations 2004 is *recommended/ not
recommended to be given to him/ her and he/ she is *qualified/ not
qualified for Full Registration.
1B. *He/ she needs to extend the training for another ___________month/s
from (date):_____________to_______________ (date).
1C. The extension of the training is because;
i) His /her performance was below 60% or /and
ii) He/ she needs to pass the Pharmacy Jurisprudence Examination
2. Master Preceptors detail:
2.1 Name:
2.2 Office address:
2.3 Master Preceptors signature: .
2.4 Date:
Page 69
Community Pharmacy
APPRAISAL BY PROVISIONALLY
[PRP] TO PRECEPTOR (optional)
REGISTERED
PHARMACIST
Setiausaha
Lembaga Farmasi Malaysia
Bahagian Perkhidmatan Farmasi
Kementerian Kesihatan Malaysia
Beg Berkunci No.924
Pejabat Pos Jalan Sultan
46790 PETALING JAYA
APPRAISAL OF PRECEPTORS
Name of Provisionally Registered Pharmacist [PRP] : .
I/C Number:
PRP Registration Number: .
Place of Training:
I have undergone training at the above place from (date): __________to:
_______(date)
Grade
Subject
1=
unsatisfactory
2=
satisfactory
3=
4=
good excellent
N/A = not
applicable
A. Facilities of
Training
Place
Comment (how things can be improved); Please make attachment where necessary)
Page 70
Community Pharmacy
B. Professional
Exposure by
Preceptors
Comment (how things can be improved); Please make attachment where necessary)
C. Professional
Guidance by
Preceptors
Comment (how things can be improved); Please make attachment where necessary)
D. Training
Skills of The
Preceptors
Comment (how things can be improved); Please make attachment where necessary)
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Community Pharmacy
Score
______
x (100%) =
64
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Community Pharmacy
Score
12
Score
12
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Community Pharmacy
Communication Skills
Assessment
Score
1.
2.
3.
4.
5.
6.
7.
8.
9.
40
PRP Personal Assessment Average Performance
1.
INDICATORS
(%)
Demonstrate a
Professional
Approach
2.
Work
Effectively
as Part of a
Team
3.
4.
Undertake
Personal and
Professional
Development
Communication
Skills
PERFORMANCE
AVERAGE
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Community Pharmacy
Appendix A
Section
Mark (%)
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Community Pharmacy
Appendix A1
(TO BE FILLED BY PRINCIPAL PRECEPTOR FOR THOSE EXTENDED)
SUMMARY OF PERFORMANCE (%) FOR EACH SECTION
MARK (%) FOR EACH SECTION
No.
Section
Mark %
prior to
extension
period
Mark % after
extension
period
Actual
extension
period
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Community Pharmacy
ACKNOWLEDGEMENTS
Advisor
Dr.Salmah binti Bahri
Pharmaceutical Services Division, Ministry of Health Malaysia
Committee Members/Participants during Bengkel Penyediaan Buku Log PRP 2012,
Kuala Terengganu, 26-29 March 2012
Mr. Amrahi bin Buang
University Malaya Medical Centre
Mdm. Zainab binti Md.Yusuf
Pharmaceutical Services Division, Ministry of Health Malaysia
Mr. Azaruddin bin Azis
Pharmaceutical Services Division, Ministry of Health Malaysia
Mdm.Yip Sook Ying
Alychem Sdn.Bhd.
Mr. Abdul Aziz bin Jamaludin
Al-Shifaa Pharmacy
Mr.Jeff Kong Jiang Foong
DF Pharmacy
Mdm.Chiew Mei Yee
Watsons Pharmacy
Mr.Soh Boon Hong
Dual Care Pharmacy Sdn.Bhd.
Mdm.Rohana binti Yusof
Exquisite Healthcare Sdn.Bhd.
Mdm. Wan Hwei Yen
GM Pharmacy Practice Guardian Pharmacy
Mdm. Winda Hayani Hasan
Hayani ADR Enterprise
Reviewer
Mr.Azman bin Yahya
Pharmaceutical Services Division, Ministry of Health Malaysia
Secretariat
Mdm. Salwati Abd.Kadir
Pharmaceutical Services Division, Ministry of Health Malaysia
Pharmacy Board Malaysia 2012
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