Physician Evaluation Form Page 2

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Physician Evaluation Form
(Example Continued)
RE: (Candidate Name)
APPLICANT EVALUATION
This evaluation should be based on demonstrated performance compared to that
reasonably expected of a practitioner at his/her level of training, experience, and
background.
1
2
3
4
0
Superior
Good
Fair
Poor
Not
Observed
EVALUATION
Basic Medical & Clinical Knowledge
Professional Judgment
Sense of Responsibility
Ethical Conduct
Emotional Stability
Competence in Clinical & Technical Skills
Cooperativeness, Ability to Work With
Others
Appearance
History & Physical Exam Taking
Medical Record Maintenance
Quality Assurance
Patient Management
Physician-Patient Relationship
Ability to Understand, Speak & Write
English
Relationship With Hospital Staff
Participation in Medical Staff
Attendance at Meetings

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