UGA Pharmacy - Experience Programs

Forms
 
Early Experience Forms/Lists of Questions

Community and Institutional Pharmacy Visits (PHRM 3100)
Community Visit Questions
Institutional Visit Questions

Long-Term Care Visits (PHRM 4900)
List of Questions

 Patient Visits (3110)

Spring Visit 1
Spring Visit 2
Spring Visit 2 - 3rd Yr Student Verification
Patient Visitation - Disease State/Medications Form
  Patient Counseling (PHRM 4950)
Evaluation Form (Pharmacist to complete)
Self Evaluation Form (Student to complete)		 Pharmacy Residency Visits (PHRM 5140)
Residency Visit Questions
Residency Program Sign Up Form
  Click here to access additional information about these "early experience" courses.

 
   
 

Physical Exam Form Adobe format
Use this form if you receive your Physical Exam at a facility other than the UGA Health Center.

Conduct Statement
 

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Clerkship Objectives
Students and Preceptors

 

 • Objectives for Community APPE
 • Objectives for Institutional APPE
 • Objectives for Direct Pateint Care APPE - use for direct patient care, acute medicine, outpatient medicine, etc.
 • Objectives for Indirect/Non-Patient Care APPE