Medical Assistant Evaluation (GCC)

Please mark the following statements with the most appropriate values. These values show the extent to which you believe your extern has shown their level of dedication.

  • (Please enter the first and last name of your extern, ex. John Smith)
  • (Please enter the number of total days attended, ex. 30)
  • (Please enter the number days absent, ex. 2)
  • (Please enter the number days tardy, ex. 1)
  • (PLEASE NOTE: A total of 160 hours is required.)

  • Clinical Procedures (100 Hours):

  • Administrative Procedures (60 Hours):

  • (If you have any other comments please leave them in this box)
  • (Please choose a letter grade)
  • (Please choose a letter grade)
  • (Please enter your name, ex. James Brown)
  • (Please enter the physician's name, ex. Dr. James Brown)
  • (Please enter the name of the company or office for which you work)
  • - -
    (Please enter the company or office telephone number)
  • (Please enter the type of practice, ex. Dialysis)
  • / /
    (Please enter today's date)