1. Understanding the APTR Appendix Forms
PMI Online Education
Understanding the Appendix Forms
Understanding the APTR Appendix Forms

2. Complete these forms accurately and turn them in on time
This video will explain the appendix forms
My supervisor
My first day
Complete these forms accurately and turn them
in on time
Congratulations on reaching the clinical externship phase of your program! This video will explain the appendix forms that came with your clinical handbook—what they are used for, how to fill them out properly, and when to turn them in.
Completing these forms accurately and turning them in on time will be vital in scheduling your board exams in a timely manner, so please pay close attention.

3. Acknowledgement of UnderstandingB C D
APPENDIX A
By signing the Acknowledgement of Understanding form, you are acknowledging that you have read and understand the information provided in your Clinical Handbook. You must submit this form prior to the start of your extern. <Flash “Send to Susan Rose” on screen> E
Acknowledgement of Understanding F

4. Fill it out accurately ARRT Competencies A B C D E F APPENDIX B
The ARRT Competencies form is used to track your competencies. You must turn it in at the end of your extern as it is a running total of your competencies. <Flash “Send to Susan Rose” on screen>
Be sure to fill it out entirely and accurately. On pages 2 through 6, fill in each column—whether the competency was mandatory or elective, the date completed, indicate whether the procedure was done on a patient or simulated, and lastly, ask your clinical instructor to sign off on the competency. E
ARRT Competencies F

5. Do not wait until the end of your extern Timesheet A B C D E F
APPENDIX C
This is your timesheet. You must turn your timesheet in every week. <Flash “Send to Susan Rose” on screen> You can fax it or you can scan it in and it. Be sure get your clinical instructor to sign off on it and then keep a copy for yourself. Do not wait until the end of your externship to turn all your timesheets in. This will cause a delay in processing your paperwork!
If you need to change your scheduled hours, please contact your clinical director via phone or to let him know of your new schedule hours <Flash “Steve’s info” on the screen>. E
Timesheet F

6. Do not wait until the end of your extern Competency Form A B C D E F
APPENDIX D
This is your Competency Form which you will use to prove competency on clinical procedures. Under “Type of Evaluation”, you will not need to mark the Recheck or the Final options. Only use the Competency, Adult, and Pediatric options.
You must turn this form in at the end of each week. You may want to send it with your timesheet which is also due each week. Once again, do not submit these forms all at once at the last minute. Doing so will cause a delay in processing your paperwork because the information must be verified and entered into the computer system which, in turn, may cause a delay in scheduling your board exam. E
Competency Form F

7. Technical and Professional Evaluation
2 Evaluations A B C D
APPENDIX E
This Technical and Professional Evaluation form must be completed by your clinical instructor who will use this form to evaluate you twice. You must turn it in at the midpoint of your extern and again, at the end of your extern. It must be signed off by your clinical instructor and turned in on time. <Flash “Send to Susan Rose” on screen> E
Technical and Professional Evaluation F

8. Pregnant women should always consult a physician
OPTION #1
Declare pregnancy
Continue program
2nd radiation monitor
Limit to low exposure
OPTION #2 B
Declare pregnancy
Continue program
2nd radiation monitor
No limit to low exposure
OPTION #3
Pregnant women should always consult a physician
Declare pregnancy
Discontinue program C D
APPENDIX F
The Pregnancy Disclosure form only applies to female students who are pregnant. It informs you of the risks of radiation during pregnancy. On page 5, any student who wishes to declare pregnancy, must sign this form acknowledging that they have received counseling regarding these risks. And on page 6, pregnant students must select 1 of 3 options.
By signing Option #1, you have voluntarily declared pregnancy and wish to continue the program with an understanding that you will be provided with a second radiation monitor that must be changed monthly, and that you will be assigned to low exposure areas. Please note that this may extend your clinical externship.
Option #2 is similar to Option #1. By signing Option #2, you have voluntarily declared pregnancy and wish to continue the program with an understanding that you will be provided with a second radiation monitor. However, in Option #2, you are choosing not to be assigned to low exposure areas.
Lastly, by signing Option #3, you are requesting to withdraw from the program with an understanding that you can re-enter the program after delivery of the baby.
For any questions about Appendix F, please feel free to contact the directors as given on this page. It is highly recommended that you also consult your physician. E
Pregnancy Disclosure F

9. to track due dates and contacts
Use the
Index of Appendices
to track due dates and contacts
Summary
Point of Contact
Index of Appendices
The Index of Appendices provides a summary of each appendix and when it is due. Use this page throughout your clinical externship to help you keep track of when you need to turn in each appendix form and who to contact for any specific questions.

10. Have You Been Paying Attention?

11. Presented by PMI Online Education