Sub-Section 3-490-76 - Paramedic Academy Terminal Competency Form

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 Paramedic education program as a minimally competent, entry-level Paramedic and as such is eligible for State and National Certification written and practical examination in accordance with our published policies and procedures.

Name of graduate:

• Overall score: % (80% minimum overall score). [PROOF ATTACHED (OzarksEMS Transcript)]
• Total contact hours: (1,000 minimum hours: 500 classroom/laboratory + 250 hospital clinical + 250 ambulance clinical [as requried by MO 19 CSR 30-40.311(2)(L)]). [PROOF ATTACHED (OzarksEMS Transcript)]
• Semester-level requirements:

• 	EMS 501 (Paramedicine I)	EMS 511 (Paramedicine II)	EMS 521 (Paramedicine III)
  ECG Quizzes (70% minimum average of all quizzes)	%	%	%
  Pharmacology Quizzes (70% minimum average of all quizzes)	%	%	%
  JBL Quizzes (70% minimum average of all quizzes)	%	%	%
  Simulations (70% minimum average of all simulations)	%	%	%
  Affective Evaluations (70% minimum "pass" rate on all evaluations)
  Final Psychomotor Exams (70% minimum on at least one attempt)	%	%	%
  Final Written Exams (70% minimum on at least one attempt)	%	%	%

• Practical skill sheets (includes all required skill sheets). [PROOF ATTACHED (Platinum)]
• Clinical tracking records (includes required hours, areas, procedures, patient contacts, etc.):
• All clinical, experience, and team lead hours meet minimum requirements. [PROOF ATTACHED (OzarksEMS)]
• Team lead patient contacts meet minimum requirements. [PROOF ATTACHED (OzarksEMS)]
• Laboratory and clinical skill meet minimum requirements. [PROOF ATTACHED (Platinum)].
• Student counseling (as applicable). Notes:
• Required course certifications:
• ACLS. [PROOF ATTACHED]
• PALS. [PROOF ATTACHED]
• Field internship mentor approval form. [PROOF ATTACHED]
• Fourth trimester post-field internship 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: NIEMT psychomotor "PASS" results [PROOF ATTACHED (NREMT)].
• Medical Director interview (if applicable).
• Student completed resource assessment survey.

Program requirements successfully and fully completed on:

Program Director signature:

Medical Director signature: