to use this form The purpose of this form is to obtain f eedback from the student regarding the internship experience so that we can improve the internship experience and help p lan future internships.
Student Contact Information
Internship Supervisor Name Facility Name
Ms. Cristal Fuller
Keystone Rehabilitation Center
Date of Internship
March 25 - April 26
Ratings Scoring Key ►
1. Amount of time spent in: a. Admission function b. Chart assembly and analysis c. Incomplete chart control d. Filing function e. Record retrieval f. Release of health information
3 Too Much
1 Not Enough
0 Not Rated or N/A Score 60
2 Satisfactory 2 Satisfactory 2 Satisfactory
0 Not Rated or N/A
g. Subpoena processing h. Faxing of h ealth information i. Other 2. Amount of time spent with Internship Supervisor 3. Amount of supervision b y employees
0 Not Rated or N/A 1 Not Enogh 2 Satisfactory 2 Satisfactory 2 Satisfactory
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Questions 1. Did you have a schedule of a ctivities for each Internship day?
Yes No 2. If no, do you feel that it would have been helpful? (Explain)
No. While at the internship site, the amount of work that is done I would consider to be a process. When work is requested it is done accordingly. For instance when starting the day I'll be notified of the task that will be done and assignment or other task that may not be to large assigned with other tasks that comes along.
3. What did you find most interesting during this…