Final LC Evaluations (for CCs) » Mobile Outreach Clinic » College of Medicine

This form is designed for Care Coordinators to provide constructive feedback to their Lead Care Coordinators for their work done in both Clinic and Care Coordination. Please complete the form honestly and as accurately as you can.

Final LC Evaluations

Evaluator (Your Name)(Required)

Lead Coordinator being Evaluated(Required)

Does this Lead Coordinator work with you in clinic or office?(Required)

Note: If you have the same LC for clinic and office, you should submit two forms (one for each shift).

Evaluation

For this Evaluation, you will be asked to rank how successful your LC is at specific roles/responsibilities. You are also given the space to comment about specific strengths or areas of growth related to these ranks.

My LC effectively communicates with the team.(Required)

Comments(Required)

My LC creates a supportive environment.(Required)

Comments(Required)

My LC knows the answer to my questions and/or is able to help me.(Required)

Comments(Required)

My LC provides me regular feedback (both positive and negative) that helps me grow as a Care Coordinator.(Required)

Comments(Required)

My LC is professional with other team members and patients(Required)

Comments(Required)

My LC is good at making decisions(Required)

Comments(Required)

Would you like to meet with your LC about final evaluations?(Required)

Yes

Unsure