Competency Name: Competency Title

Patient Family Centered Care Patient Interaction Competency Patient Service Representative

Documentation Employee Name: ______A. Observation of Simulation/Mock Event EMPLID: ______B. Competency Assessment: Department Observation Title: ______C. Verbal Discussion: Use only if no opportunity to observe. Unit: ______N/A If an element does not apply.

Critical Elements Validated (Staff can self assess by checking boxes to the left of each element) A Department (B) C A.I.D.E.T. ACKNOWLEDGE the patient by smiling, making eye contact and greeting them. A.I.D.E.T. INTRODUCES SELF to patient. TWO PATIENT IDENTIFIERS – Ask patient to state name and view ID card. Include KEY WORDS. MANAGE UP – Team members; i.e. doctor, nurse, phlebotomist, ancillary services, self A.I.D.E.T. EXPLANATION - EDUCATE .Request insurance card. Use KEY WORDS – “to verify we have your information correct.” .Confirm demographics. Use KEY WORDS – “to ensure we can reach you if we need to.” .Scan the insurance card. Use KEY WORDS – “to ensure billing goes to the right place.” .Collect co-pay. Use KEY WORDS – Advise patient to bring to the appointment while scheduling. .Prepare the receipt. Use KEY WORDS – “Here is a receipt for your records.” .Give patient a copy of their Medication Profile. Use KEY WORDS. A.I.D.E.T. DURATION – Explain delays, offer conveniences . WHITE BOARD – (Clinic Physician Status board) Explain the board. ENGAGE - QUESTIONS – ‘Do you have any questions for me?’ NOTE PAD - Encourage patient to write questions for provider. KEY WORDS AT KEY TIMES – Safety, comfort, privacy explain, etc. A.I.D.E.T. THANKS THEM SERVICE RECOVERY – I.C.A.R.E. .INTEREST .CONCERN .APOLOGIZE .RESPOND .EDUCATE

SIMULATION VALIDATOR: Initial ______Sign ______Date ______

COMMENTS:

Return to Center for Education and Development at DC030.00 or Fax to 573-884-5215 Employee Name: ______EMPLID: ______

DEPARTMENT VALIDATOR: Initial ______Sign ______Date ______DEPARTMENT VALIDATOR: Initial ______Sign ______Date ______DEPARTMENTOBSERVATIONS : VALIDATOR: Initial ______Sign ______Date ______OBSERVATIONS : OBSERVATIONS :

EXPECTATIONS FOR IMPROVEMENT: EXPECTATIONS FOR IMPROVEMENT: EXPECTATIONS FOR IMPROVEMENT:

EMPLOYEE ACTION PLAN: (Must address each expectation for improvement) EMPLOYEE ACTION PLAN: (Must address each expectation for improvement) EMPLOYEE ACTION PLAN: (Must address each expectation for improvement)

COMPETENCY DEMONSTRATED: FINAL VALIDATOR: ______Date: ______

Return to Center for Education and Development at DC030.00 or Fax to 573-884-5215