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NEVADA STATE BOARD OF PHARMACY 431 W. Plumb Lane ? Reno, NV 89509 PHONE 775/850-1440 ? FA — 775/850-1444 PRECEPTOR REPORT FORM INTERN PHARMACIST This form can only be used to report intern hours
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How to fill out a preceptor report form application:

01
Start by reading the instructions provided on the form. Familiarize yourself with the required information and any specific guidelines mentioned.
02
Begin by entering your personal details in the designated fields. This may include your name, contact information, and any relevant identification numbers.
03
Next, provide information about the organization or institution you are affiliated with as a preceptor. This may include the name, address, and contact details of the organization.
04
The form may require you to provide details about the preceptorship program, such as the dates of the program, its objectives, and the specific tasks you were assigned as a preceptor.
05
Take the time to accurately describe your role and responsibilities as a preceptor. This may include mentoring and supervising students, evaluating their performance, and providing feedback and guidance.
06
The form may include sections that ask for an assessment of the student's performance during the preceptorship. Provide honest and constructive feedback about the student's strengths, areas of improvement, and overall performance.
07
If applicable, be sure to provide any additional information or comments that may be helpful for the evaluation process. This could include notable incidents or achievements during the preceptorship.
08
Review the completed form for any errors or missing information. Make necessary corrections before submitting it.
09
Keep a copy of the completed form for your records.

Who needs a preceptor report form application?

01
Students in healthcare or educational fields who are completing a preceptorship as part of their training or curriculum.
02
Preceptors who are responsible for mentoring and supervising the students during their preceptorship.
03
Educational institutions or organizations that require documentation and evaluation of a preceptorship program.
04
Regulatory bodies or accrediting agencies that oversee the quality and standard of preceptorship programs.
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The preceptor report form application is a form used to report information about a preceptor who is supervising a student or trainee in a specific field.
Preceptors who are supervising students or trainees are required to file the preceptor report form application.
To fill out the preceptor report form application, the preceptor must provide information about themselves, the student or trainee being supervised, and details about the supervision.
The purpose of the preceptor report form application is to document and track the supervision of students or trainees by preceptors in a specific field.
The preceptor report form application must include information such as the preceptor's name, contact information, the student or trainee's name, program details, and hours of supervision.
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