Pacific University School of Pharmacy 2015-2016

advertisement
Pacific University School of Pharmacy 2015-2016
Advanced Pharmacy Practice Experience (APPE)
sopexperiential@pacificu.edu or FAX (503) 352-7398
Contacts: Jeremy Hughes (jeremy.hughes@pacificu.edu), Courtney Kraus (courtney.kraus@pacificu.edu)
Nora Garfias (nora.garfias@pacificu.edu), Rita Barton (bartonr@pacificu.edu)
Name of Facility:
Primary Preceptor/Coordinator:
Facility Address/City/State/Zip:
Preceptor Phone:
_Email:

 Please check the box below that best describes the experience your site offers.
For multiple rotation types, complete one
sheet per rotation type (i.e. one sheet for Community Pharmacy rotations, a second sheet for Elective rotations, etc.) For
assistance planning multiple rotations please contact the Experiential Team.
Required/Core Student Coursework
Elective Student Coursework (Elective Description)

 Advanced Community Pharmacy

 Patient Care Elective
_______________________________________________________
_______________________________________________________

Non-Patient Care Elective
_______________________________________________________
_______________________________________________________
APPE
APPE
APPE
APPE
APPE
APPE
APPE
APPE
5/11/156/19/15
6/22/157/31/15
8/3/159/11/15
9/14/1510/23/15
10/26/1512/4/15
12/28/152/5/16
2/8/163/18/16
3/21/164/29/16
Circle
Number of
Students:
Circle
Number of
Students:
Circle
Number of
Students:
Circle
Number of
Students:
Circle
Number of
Students:
Circle
Number of
Students:
Circle
Number of
Students:
Circle
Number of
Students:
1 2 3 4
1 2 3 4
1 2 3 4
1 2 3 4
1 2 3 4
1 2 3 4
1 2 3 4
1 2 3 4
Other #___
Other #___
Other #___
Other #___
Other #___
Other #___
Other #___
Other #___
TOTAL
NUMBER
of APPE
STUDENTS
Download