e . Available , responsive to ER f . Demonstrates ethically sound practices .
� No Concerns
� Concerns / explanation : ___________________________________________________________________________________________ ___________________________________________________________________________________________ ___________________________________________________________________________________________
============================================================================================== FINAL ASSESSMENT :
� Performing within desired expectations , recommend appointment / reappointment / Active category
� Performing within desired expectations , recommend Active category
� FPPE to continue
� The possibility of risk to patient safety exists
_____________________________________________________ Mentor / Proctor Signature
____________________________ Date
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