Fresenius KabiCare Stimufend Clinical Adherence Simulation Evaluation

created 2022.01.04
Name: 


A red asterisk (*) indicates required questions.

  1. Please enter the following:

    Name of Nurse:

    Patient Profile #:

    Scenario Description:

    Room #:

    Name of Simulator:
    *


  1. Is the nurse following the appropriate Call Guide for the patient interaction?*
    Yes
    No


  1. Does the nurse verify patient HIPAA?*
    Yes
    No


  1. Does the nurse ask the patient if they would like a copy of the Prescribing Information?*
    Yes
    No


  1. Does the nurse ask the patient if there is a family member, spouse, or friend they would like to include as part of discussion? *
    Yes
    No


  1. Does the nurse provide product support overview for the program?*
    Yes
    No


  1. Does the nurse uncover potential barriers the patient or their loved ones are facing that would prevent the patient from keeping their administration visits? *
    Yes
    No


  1. Does the nurse confirm the patient’s communication preference?*
    Yes
    No


  1. Does the nurse set expectations on what’s to come next for the patient?*
    Yes
    No


  1. Any feedback you would like to share?