Performance Review Template Pharmacy

PHARMACY PERFORMANCE EVALUATION & COMPETENCY RECORD

DOCUMENT CONTROL

• Effective Date: [Date]
• Version: 1.0 (Standard Clinical Operations)
• Jurisdiction/Scope: [State/Province/Region] Pharmacy Practice Acts & Employment Law

1. LEGAL NOTICE & DISCLAIMER

This document is a formal record of professional performance and clinical competency. It is not an employment contract. The contents herein may be used as evidence in personnel decisions, regulatory audits, or disciplinary proceedings. [Company Name] reserves the right to amend this document to comply with evolving Board of Pharmacy regulations or state labor statutes.

2. PARTIES & IDENTIFICATION

• Company: [Company Legal Name] (“Employer”)
• Employee: [Full Legal Name] (“Employee”)
• License/Registration No: [License Number]
• Review Period: From [Start Date] to [End Date]
• Reviewer: [Name and Title]

3. OPERATIVE CLAUSES & PERFORMANCE METRICS

Clause I: Clinical Competency & Regulatory Compliance The Employee acknowledges the duty to maintain active licensure and adhere to all DEA, FDA, and State Board of Pharmacy statutes. Performance shall be measured by the error-free execution of dispensing, clinical verification, and adherence to HIPAA/HITECH privacy protocols.

Clause II: Operational Workflow & Accuracy Performance is assessed against Key Performance Indicators (KPIs) including:

1. Verification Accuracy: Percent of prescriptions verified without clinical or technical error.
2. Inventory Integrity: Adherence to Controlled Substance Act (CSA) requirements for documentation and reconciliation.
3. Turnaround Efficiency: Sustaining pharmacy throughput benchmarks as defined in the [Company Operations Manual].

Clause III: Professional Conduct & Interdisciplinary Collaboration The Employee must demonstrate professional communication with patients, healthcare providers, and pharmacy staff. Any deviation from workplace safety or discriminatory conduct constitutes a material breach of professional expectations.

4. EVALUATION SCORING (1-5 Scale)

(1: Below Expectations | 3: Meets Expectations | 5: Exceptional)

• Clinical Accuracy & Safety: [Score] | Comments: [_________________________]
• Regulatory Compliance/Audits: [Score] | Comments: [_________________________]
• Efficiency & Productivity: [Score] | Comments: [_________________________]
• Professional Development/Clinical Knowledge: [Score] | Comments: [_________________________]

5. EXECUTION & ACKNOWLEDGMENT

By signing below, the Employee acknowledges they have reviewed this assessment, understand its contents, and have had the opportunity to provide written rebuttal or additional comments.

Employer Signature: __________________________ Date: [Date] Printed Name & Title: [Name / Title]

Employee Signature: __________________________ Date: [Date] Printed Name: [Full Legal Name]

6. STEP-BY-STEP EXECUTION GUIDE

1. Clinical Review: Prior to the meeting, the Reviewer must pull the Employee’s error logs, incident reports, and PMP (Prescription Monitoring Program) compliance audits to ensure factual accuracy of the scoring.
2. Formal Review Meeting: Conduct the evaluation in a private setting. Ensure the Employee understands that this document will be placed in their permanent personnel file.
3. Conflict Resolution: If the Employee disputes any score, allow them to append a "Statement of Disagreement" to this document. Both parties must initial the appended page to acknowledge its addition.
4. Compliance Filing: Retain the signed original in a secure, encrypted digital or physical personnel file in accordance with local record retention mandates (e.g., typically 3–7 years).