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INITIATION OF O2 THERAPY VIA NASAL CANNULA / SIMPLE MASK / WITH HUMIDIFIER

RATING

Satisfactory (performs without supervision)

Competent (no critical errors, corrects with some coaching)

Unsatisfactory (critical errors, requires remediation)

Evaluator Signature: _______________________________________________________    Date: ____________________

Comments/Remedial Action Plan:  _______________________________________________________________________

Student Signature: _________________________________________________________    Date: ____________________

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