Physician Performance Evaluation/Self-Evaluation Form

The physician evaluation/self-evaluation form is intended to be used for ongoing physician performance evaluations, primarily including an annual evaluation. The document is setup to track the performance of general competencies, job specific duties, and current/future goals. 

Instructions are included on the form; however, it is intended to first be completed by the physician as a self-evaluation and then by the evaluator for the final evaluation. The form is setup to auto-calculate the total performance rating on a scale from 1-5 based on the ratings entered by the evaluator.