This form can be used to document a practitioner’s level of engagement at a facility by assessing not only clinical activity—or lack thereof—but other general competency elements such as patient care (NPDB query) and professionalism (participation in continuing medical education).

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Facilities seeking competency data may need to amend their policies or medical staff bylaws. These samples can be customized for most facilities, but consult with counsel first.

This free resource is a sample reappointment OPPE scorecard courtesy of Beebe Healthcare, a nonprofit community hospital in Lewes, Delaware, that upholds professional practice evaluation as one landmark in the greater quality landscape. 

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