Physician Assistant Shadowing Patient Contact Hours Form 2026

1. Click ‘Get Form’ to open it in the editor.
2. Begin by entering your Legal Last Name, Legal First Name, and Middle Initial in the designated fields. Ensure accuracy as this information is crucial for identification.
3. Input your Student ID number in the appropriate section to link your shadowing hours to your academic record.
4. Fill out the Agency name, Address, City, State, and Zip code where you completed your shadowing experience.
5. Provide the Supervisor’s Name/Title and their Phone Number for verification purposes.
6. Indicate the Type of shadowing/patient contact experience you had and specify the Dates of your experience by filling in 'From' and 'To' fields.
7. Calculate and enter the Total number of hours spent in shadowing/direct patient contact.
8. Evaluate yourself based on the criteria provided (Dress, Promptness, Follows instructions, Attitude) by selecting a rating from 1 to 5 for each category.
9. Finally, ensure that both you and your supervisor sign and date the form before submission.

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