APPENDIX V - TEMPLATE FOR RESPONSE TO DIVERSITY EXEMPLAR WORKSHEET (NC III) (1) 3-24-18.docx

APPENDIX V - TEMPLATE FOR RESPONSE TO DIVERSITY EXEMPLAR WORKSHEET (NC III) (1) 3-24-18.docx

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APPENDIX V - T EMPLATE FOR RESPONSE TO DIVERSITY EXEMPLAR WORKSHEET (NC III ) (Meets requirements for Response to Diversity Competency: RD III b) ______________________________________________________________________________ Exemplar for Response to Diversity Worksheet (Provide an exemplar [preferably within last 12 month] demonstrating the candidate’s response to diversity. The exemplar should reflect the candidate’s competency in applying principles of responding to diversity in practice by describing how the candidate responded to an unusual or non-typical actual patient care situation where cultural needs were identified and addressed. The example should be comprehensive and detailed, and must extend beyond basic accommodations, such as language translation interpretation and/or compliance with cultural or religious food restrictions found commonly in our patient population. Response should include a description of the essential indicators. Be prepared to identify patient, if necessary. Fill in the form below. Place cursor in box to begin typing or choose your response using the drop-down boxes, as appropriate. Form must be TYPEWRITTEN. Ensure you answer or respond to the question completely. Consideration will be given to quality of writing skills [e.g., spelling, punctuation, coherency, etc.].) Name: Marie Dort Date: 1/29/2018
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