Mid-Semester 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. Please complete the form as honestly and as accurately as you can. Please fill out an evaluation for EACH of your LCs (both OFFICE and CLINIC LCs). This form is REQUIRED so please provide constructive and truthful feedback!

Please use the following google document to aid you in writing feedback for your LC: https://docs.google.com/document/d/1f9MI77Qowl1GYYrF3mzhALeCRupL_Xx-476zczR-3go/edit?usp=sharing

This form is due Sunday, October 12th at 11:59 PM.

Mid-Semester 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 use the google document liked at the top of this page to provide feedback to your LC. Please be sure to write a minimum of one full paragraph.

Evaluation(Required)

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