Sub-Section 3-385-70 - EMT Intern Academy Terminal Competency Form

CMH EMS Education Manual

Citizens Memorial Hospital - Emergency Medical Services Education Department hereby certifies that the candidate listed below has successfully completed all the terminal competencies required for graduation from the EMT internship education program as a minimally competent, entry-level EMT, has completed State and National Certification written and practical examination, and department onboarding in accordance with our published policies and procedures.

Name of graduate:

Overall score: % (80% minimum overall score). [PROOF ATTACHED (OzarksEMS Transcript)]
Practical skill sheets (includes all required skill sheets). [PROOF ATTACHED (Platinum)]
Clinical tracking records (includes required hours, areas, procedures, patient contacts, etc.):

All clinical and experience hours meet minimum requirements. [PROOF ATTACHED (OzarksEMS)]
Laboratory and clinical skill meet minimum requirements. [PROOF ATTACHED (Platinum)].

Final exams:

Cognitive: Platinum timed comprehensive adaptive test, or cumulative summary results with "Good" in all categories.[PROOF ATTACHED (Platinum)]
Affective: Final comprehensive eval with "PASS" status. [PROOF ATTACHED (Google Drive)]
Psychomotor: Final psychomotor "PASS" results [PROOF ATTACHED (Eval Form)].

Student counseling (as applicable). Notes:
Required course certifications:

AHA BLS. [PROOF ATTACHED]
NAEMT PHTLS. [PROOF ATTACHED]

BEMS skills verification form completed (https://health.mo.gov/safety/ems/pdf/TrainingEntityEMT-BSkillsVerification.pdf)
All checklists completed with signatures.
Manager has reviewed a completed ePCR by this employee and completed both a documentation and clinical review.
Intern has sucessfully completed a final evaluation shift with a Manager (or Crew Leader).

Program requirements successfully and fully completed on:

Medical Director signature (optional):

Program Director signature:

Change Log:

Date	Link to previous version	Description of change
11/24/21		Created this section.
12/30/22	pdf	Removed exceptional requirement from adaptive testing.

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Based on a work at http://ozarksems.com/edman-4-240.php.

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