Experiential Rotations Forms

For additional information, contact:

Christy F. Cox, M. Ed., Pharm. D.
Experiential Program Coordinator
SWOSU Pharmacy Practice Department
Pasteur Medical Building
1111 North Lee, Suite #241
Oklahoma City, OK 73103
(405) 601-8335
Fax: (405) 601-1201
christy.cox@swosu.edu

During the experiential part of the program the student will be assigned to eight (8) professional experiences each lasting four (4) weeks. These consist of

three (3) Medicine
two (2) Community
one (1) Institutional
one (1) General Selective
one (1) Selective Medicine

The student is allowed to submit areas of interest for the General Selective and Selective Medicine experiences.

On-Line Pharmacy Experiential Site Evaluations. Please complete this evaluation. It will help us improve the Pharmacy Practice rotation experience. You and your answers will be kept anonymous. Thanks

General Selective Sites	Review these sites prior to the Informational Meeting.
Medicine Selective Sites	Review these sites prior to the Informational Meeting.
*Concurrent Hours - from Intro to Pharmacy & Pharm Care Labs (must be filled out prior to deadline)	DOC format Adobe Acrobat format
*Immunization Requirements Prior to going on Experiential Rotations	Requirements
*Informed Consent Regarding Hazards on Clinical Rotations (to be read, signed and turned in at the Briefing Meeting)	DOC format Adobe Acrobat format
*OSBI Background Check (The sex offender option must be checked or another check will have to be done.)	HTML page
*Placement Application Form (request for sites, must be filled out prior to deadline)	DOC format Adobe Acrobat format
*Student Agreement Form (to be signed and dated and returned prior to deadline)	DOC format Adobe Acrobat format
*Vitae Form (to be filled in completely and returned prior to deadline)	DOC format Adobe Acrobat format
Change of Assignment request form instructions (if you want to change your assignment)	Adobe Acrobat format
Laboratory Data Sheet (to help the student follow the patient's lab data)	DOC format Adobe Acrobat format
Patient Profile Sheets - DOC format is better (to assist the students on their rotations)	DOC format Adobe Acrobat format
Practicum Experience Report (to let the student know where their concurrent hours came from)	DOC format Adobe Acrobat format
Student Evaluation of Experiential Experience Site (filled out by the students upon completion of their rotation)	On-Line Evaluations
Student Grade Sheet (experiential rotation evaluation)	DOC format Adobe Acrobat format
Summary of Laboratory Data (a more comprehensive lab data sheet)	DOC format Adobe Acrobat format

Forms noted with an asterisk (*) MUST be returned to the Pharmacy Practice Office by the deadline or you will NOT be allowed to go on rotations!

If your contact information changes (e-mail address, mailing address, and/or phone number), please contact Mrs. Kathy Bell (405) 601-2484 as soon as possible.

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Experiential Rotations Forms