7/23/23, 12:34 AM Patient Counseling Rubric | Drake University

Patient Counseling Rubric

Part 1 – Introduction and Patient History Not Completed Comments
completed

1.Greets patient (hi, hello, handshake, etc.) 0 0.5  

2.Introduces self (name) 0 0.5  

3.States title (i.e., student pharmacist) 0 0.5  

4.Explains purpose of counseling session (best 0 0.5  

benefits/safety)

5.Asks permission 0 0.5  

6.Confirms patient name 0 0.5  

7.Confirms date of birth 0 0.5  

8.Verifies phone number 0 0.5  

9.Verifies address 0 0.5  

10.Collects past medical history (medical 0 0.5  

conditions)
11.Verifies patient allergies 0 0.5  
(drug/environmental/food and reaction)
12.Verifies Rx medications 0 0.5  

13.Verifies OTC medications 0 0.5  

14.Vitamin use 0 0.5  

15.Herbal supplement use 0 0.5  

16.Sample medication use 0 0.5  

Part 2 – Basic Counseling Points Not Completed Comments

completed

17.Provides medication name 0 1  

18.Brand or generic medication 0 1  

19.Assesses prior knowledge – what did 0 1  

doctor tell you this was for?
20.Provides indication for medication 0 1
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7/23/23, 12:34 AM Patient Counseling Rubric | Drake University

33.Common ADRs (provide at least 3) 0    1    2   3  

34.Severe ADRs 0 1  

35.Management of ADRs (common & severe 0 1  

ADRs mentioned)
36.Discusses warnings and precautions 0    1    2    3  
(pregnancy, alcohol, etc when applicable)
37.Discusses drug-drug interactions (need to 0 1  
verbalize if none)
38.Other drug interactions (disease/food 0 1  
interactions; skip if none)
39.Where do you store your medications? 0 1  
(give suggestions)
40.Store away from kids/pets 0 1  

41.Beneficial non-drug activities (diet, 0 1  

exercise, keep appts, etc)
Part 3 – Counseling Session and Not Completed Comments
Communication completed

42.Checks for patient understanding (corrects, 0 1  

reinforces)
43.Summarizes key points (at least 3) 0 1  

44.Probes for questions 0 1  

45.Identifies/addresses any real or anticipated 0 1  

concerns (anytime)
46.Offers follow-up 0 1  

47.Uses open ended questions throughout 0   1   2  

session
48.Logical and sequential order used 0 1  

49.Patient friendly language used (no jargon) 0 1  

50.Appropriate non-verbal behavior (eye 0 1  

contact, body language)
51.Maintains control and direction of 0 1  
counseling session
52.Professionalism (dress, attitude, 0 1  
communication)
53.Overall presentation style 0 1  

Part 4 – Special Instructions (OPTIONAL Points Awarded Comments

SECTION)
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54.Special Instructions addressed (ex. Eye 0-10