Introductory Pharmacy Practice Experience (IPPE) Forms
IPPE Program Overview
Use the following link to view a description of our IPPE program, requirements, competency check lists and evaluation forms. All forms listed in this section are available in this booklet.
IPPE Preceptor Application
All preceptors must complete the following form the first time he or she precepts a UF student (either by using the web-based version or by printing and returning via fax or mail to the Director of Experiential Education).
IPPE 50 Hours at One Site Ranking Form (Lavender Form)
This form must be completed by the student and turned in to the office or faxed to 419-434-5583 before the student starts their IPPE hours. This form is due first and second semester. Two preceptors must selected. In the event that the first choice is not be available, the second choice will be contacted.
Experiential Competency Checklist
Students taking part in experiential education at The University of Findlay are required to complete tasks that demonstrate their competency in certain areas. Preceptors should use this form to check off each competency as it is met. Each course (Phar 350, Phar 351, Phar 491, Phar 492, Phar 591, and Phar 592) has a separate checklist that must be completed. Following a student's participation in experiential education, preceptors should evaluate the student's abilities using the evaluation tool completed online through RxPreceptor.
IPPE Student Evaluation of Preceptor & Site
Students are required to complete the following evaluation of their preceptor and site following the completion of each 50 hours. This form is required to be completed online using RxPreceptor.
This evaluation page allows students to rate their pharmacist mentors. This form is needed for successful completion of the PHAR 350, PHAR 351, PHAR 491, PHAR 492, PHAR 591 and PHAR 592 courses.
Pharmacist Mentor Review (PDF)
Advanced Pharmacy Practice Experience (APPE) Forms
APPE Program Overview
Use the following link to view a description of our APPE program, requirements, policies and evaluation forms. All forms listed in this section are available in this booklet.
Student Evaluation Form
The preceptor is to complete the “First Evaluation” section of this form during the middle week of the rotation. The “Final Evaluation” section and final grade should be completed during the last week of the rotation. During the First and Final Evaluations of the student, the preceptor will discuss the student’s strengths and weaknesses. Although First and Final Evaluations are required, only the Final Evaluation will be used in determining the student’s grade for the rotation. The Final Evaluation should indicate the student’s level of competence upon completion of the rotation. The preceptor will also keep a copy on file. The original form must be submitted on line electronically via the RxPreceptor website to the Director of Experiential Programs no later than the last day the rotation. PharmD Student Rotation Evaluation Form (PDF)Student Self-Assessment Form. The student must complete a self-evaluation at the end of each rotation. The completed evaluation will be included as part of the Professional Portfolio. This evaluation should be discussed with the preceptor prior to the completion of the rotation.Student Self Assessment Form (PDF)
Longitudinal Outcome Measures Assessment Form
During the Advanced Practice Rotations, the student must complete all longitudinal outcome measures. Upon completion of each outcome measure, the preceptor or Hub Site Coordinator shall evaluate the student’s performance. The preceptor should discuss the evaluation with the student. The student must include the original assessment form with the professional portfolio (RxPortfolio) at the end of the rotation sequence. The student may create an additional rotation tab with titling it “Longitudinal Outcome Measures Assessment Form” Each student is responsible for completing all activities listed on this form.
Longitudinal Outcome Measures Assessment Form (PDF)
Journal Club Evaluation Form
Many rotation sites require the student to give a verbal journal club presentation. This is a representative copy of the evaluation form the preceptor may choose to utilize. This form is NOT a required form. However, if this form is completed by the preceptor, it should be included as part of the Professional Portfolio (RxPortfolio).
Student Journal Club Evaluations (PDF)
Preceptor Evaluation Form
The student is required to complete this form at the end of the month to evaluate the rotation site using RxPreceptor website to submit an electronic copy to the Director of Experiential Education.
Preceptor Evaluation Form (PDF)
Case Presentation Evaluation Form
Many rotation sites require the student to give verbal case presentations. This is a representative copy of the evaluation form the preceptor may choose to utilize. This form is NOT a required form. However, if this form is completed by the preceptor, it should be included as part of the Professional Portfolio (RxPortfolio).
Case Presentation Evaluation Form (PDF)
Patient Communication Evaluation Form
Each student must complete ONE (1) Patient Communication Evaluation during the rotation sequence. The preceptor may enact the part of the patient, may assign another colleague to enact the part of the patient, or assign a real patient for the student to interact with. The student should be observed and evaluated based upon the criteria provided on the Patient Communication Evaluation Form. This form should be submitted as part of the Professional Portfolio (RxPortfolio) at the completion of the rotation sequence.
Patient Communication Evaluation Form (PDF)
Absence Request Form
Each student should use the Absence Log in RxPreceptor located under Additional Modules tab, to request approval for time off during a rotation. The student shall also contact (in person or by phone) the preceptor as soon as he/she knows of their absence.
Other Helpful Links
Ohio State Board of Pharmacy