DA Observations

Observation Completed By *

First

Last

Date *

Patient's Name *

First

Last

Team Members Involved *

DA's uniform/attire

Greeting and Introduction

Small talk initiation

Offer of Comfort Menu

Discussing scheduled treatment

SDS opportunity discussed

Accurate use of bluenote

Doctor introduction

Comments regarding assisting

Proper use of care card and giving post op instruction

Routing slip ready and updated

Discussed next steps regarding treatment/PCV

Handoff to Business Team

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