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CERTIFIED NURSE AIDE TRAINING PROGRAM (NATP) …

_____ BPSS Health Form 105a - Revised 03/03/16 - Adapted from BPSS NURSE Aide TRAINING Booklet and NYS Dept. of Health Curriculum CERTIFIED NURSE AIDE TRAINING PROGRAM (NATP) clinical skills PERFORMANCE RECORD EVALUATION CHECKLIST CNA STUDENT NAME: _____ SCHOOL NAME: _____ INTERNSHIP SITE (full name and address):_____ PRIMARY INSTRUCTOR: _____INTERNSHIP SUPERVISOR: _____ DATES OF CNA TRAINING : FROM ____/____/____ TO ____/____/____ DATES OF INTERNSHIP: FROM ____/____/____ TO ____/____/____ These mandated skills can be demonstrated by the student in the skills lab or during the internship.

BPSS Health Form 105a - Revised 03/03/16 - Adapted from BPSS Nurse Aide Training Booklet and NYS Dept. of Health Curriculum . CERTIFIED NURSE AIDE TRAINING PROGRAM (NATP) CLINICAL SKILLS PERFORMANCE RECORD EVALUATION CHECKLIST . CNA STUDENT NAME: _____

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