MAEB MEDICAL ASSISTANT EXTERNSHIP BOOKLET

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1 MEDICAL ASSISTANT EXTERNSHIP BOOKLET

2 Externship Booklet The Externship Booklet includes important guidelines and documents for students to successfully complete their externship. Students are required to bring their Externship Booklet with them to class and to their externship each day. For more information refer to the Student Handbook. Please complete the following: Student Name: Program Location: Start Date: Mailing Address: Phone Number: Externship Site: Preceptor Name: Externship Schedule: Externship Address: Externship Phone: A NOTE TO THE PRECEPTOR Thank you for hosting our healthcare training student. We appreciate your contribution to the success of our students. Please contact the Instructor immediately if you have any questions or concerns. This booklet contains all of the paperwork required for the student to complete the program. Here is a list of what we ask of you: Student s Schedule: Verify student s externship schedule. Externship Sign-In Log: Sign off on the dates and hours the student has completed on a daily basis. Skills Checklist: Initial next to each skill that the student either performs or observes in your clinical setting. We hope students will experience as many of these skills as possible, however the student is not required to have all of the skills signed off during the externship. Student Evaluation Form: To be Completed by preceptor at the end of the externship. It is the student s responsibility to provide a copy of the externship booklet to the Instructor. Thank you again for your participation.

3 Health Care Portability and Accountability Act (HIPAA) Form Dear Student, Confidentiality: You are required to maintain confidentiality of patient information in accordance with state and federal law. No student will have access to or have the right to review any medical record, except where necessary in the regular course of the program. The discussion, transmission, or narration in any form by students of any patient information obtained in the regular course of the program is forbidden except as permitted by law. Please review and sign this Health Insurance Portability and Accountability Act (HIPAA) form. HIPAA STATEMENT Notification of privacy practices in accordance with the Health Insurance Portability and Accountability Act (HIPAA) was distributed and discussed during the classroom portion of this program. It is your responsibility as a student to be able to define the HIPAA regulations. You should be able to describe how the regulation affects you in your position in the allied healthcare field. Please review the HIPAA notification thoroughly and keep it with your Externship Booklet. I have read and understand the HIPAA regulations. (Please Print and Sign Your Name) Print Name Signature Date

4 Externship Sign-in Form Student Name: DATE LOCATION TIME IN TIME OUT PRECEPTOR S INITIALS

5 Externship Sign in Form Continued Student Name: DATE LOCATION TIME IN TIME OUT PRECEPTOR S INITIALS Attach additional time sheet if need

6 Externship Site Supervisor Evaluation Form The Student Externship Evaluation should be filled out by the student s preceptor on or before the last day of the externship. Fill in the student information below and ask your preceptor to complete the form. Student Name: Program Location: Start Date: End Date: Please evaluate the above named student in the following areas. Rating are as follows: 5 = Strongly Agree 4= Agree 3 = Neutral (acceptable) 2 = Disagree 1 = Strongly Disagree 0 = Not Observed General Skills Evaluate the students ONLY on skills practiced, by entering the appropriate rating. If there were no opportunities to observe a specific skill, please enter 0 for Not Observed. Externship Skills Enter Rating The Extern communicates effectively in the workplace. The Extern collaborates respectfully in groups with awareness of the positive contributions of diversity to group success. The Extern accepts supervision and works effectively with supervisory personnel. The Extern is able to identify, retrieve, evaluate and use the information needed to succeed in the position. The Extern demonstrates a profession behavior. The Extern contributes to a positive work environment. The Extern can synthesize information, solve problems, and make decisions at a level appropriate to his/her future position in this field. Medical Assistant Skills Using the rating scale, evaluate the students ONLY on specific functions performed. If there were no opportunities to observe a specific skill, please enter 0 for Not Observed. Externship Skills Enter Rating The Extern use correct terminology. The Externs has the ability to adapt to new procedures and/or processes. The Extern properly care for the instruments and equipment. Please list and evaluate any additional duties performed by this Extern.

7 The Extern is sensitive to patient comfort. Please list and evaluate any additional duties performed by this Extern below: Overall Appraisal of Student How satisfied overall are you with this Extern? (4 = very satisfied; 3 = satisfied; 2 = average; 1 = unsatisfactory Note to preceptors: Marking Unsatisfactory means that the student, in your opinion, is not prepared for the role of a Medical Assistant. However, this does not necessarily mean the student cannot pass the course under certain conditions to be determined by the School. Please provide additional information on the student below. Student appears to show strength in these areas: Student could benefit from suggestions for improvement in these areas: If the Extern has been hired for employment at your company, please check here: Signature: Printed Name: Title: Site Name Date Phone Number: Address

8 Medical Assistant Certification Application Process You will be eligible to apply to the California Certifying Board for Medical Assistants once you have successfully completed the program, externship, received a certificate of completion and paid your tuition in full. To apply, click here to print the application. After completing the application, you must send it to the California Certifying Board for Medical Assistant along with the following documents: Certificate of Competency for Injections and/or Venipuncture. This form is found on page 3 of the application and must be signed by your instructor in order to sit for the CMA Exam. Copy of your CPR card. Pay the application fee. Send the documents to: California Certifying Board for Medical Assistants PO Box 462 Placerville, CA Upon approval of your application, you will be notified of scheduling instructions for the exam. To become certified, you must pass the exam. Once certified, your certificate, wallet card and pin will be mailed to you along with re-certification information. Go to to download a free Examination Study Outline. For more information on becoming certified go to

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