Medical Scribing Feedback Form
Provide your feedback on the performance and effectiveness of the medical scribe. Your input helps improve quality and service.
Name of Medical Scribe
*
Your Name
*
Your Role
*
Please Select
Physician
Nurse
Medical Assistant
Administrator
Other
Department/Unit
*
Date of Evaluation
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Please rate the following aspects of the scribe's performance.
*
Rows
Excellent
Good
Fair
Poor
Accuracy of documentation
1
2
3
4
Timeliness of note completion
5
6
7
8
Professionalism and demeanor
9
10
11
12
Confidentiality and privacy practices
13
14
15
16
Communication with provider
17
18
19
20
Understanding of medical terminology
21
22
23
24
Overall rating of the scribe's performance
*
1
2
3
4
5
What are the scribe's strengths?
Areas for improvement or suggestions
Would you recommend this scribe to other providers?
*
Yes
No
Not Sure
Submit Feedback
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