Physician Performance Evaluation
Physician Performance Evaluation
Physician Under Review: Date of Review: / /
Section 1: Patient Care
Quality of care: 1 2 3 4 5
Adherence to QA standards: 1 2 3 4 5
Appropriateness of Diagnostics and Therapeutics: 1 2 3 4 5
Continuing Medical Education (CME) Requirements met: Y / N
Section 2: Communication and Interaction
Communication and interaction with fellow providers: 1 2 3 4 5
Communication and interaction with staff: 1 2 3 4 5
Communication and interaction with patients and families: 1 2 3 4 5
Patient satisfaction: 1 2 3 4 5
Communication with referring physicians (including timeliness and thoroughness):
1 2 3 4 5
Timeliness, legibility, and thoroughness of documentation: 1 2 3 4 5
Section 3: Other
Financial contribution and workload: 1 2 3 4 5
Punctuality: 1 2 3 4 5
Attitude: 1 2 3 4 5
Flexibility: 1 2 3 4 5
Participation in group activities, meetings, projects: 1 2 3 4 5
Comments:
Comments/response from physician under evaluation:
Signatures:
____________________________________
Medical Director Date
____________________________________
Physician Date
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