2. Complete the INITIAL EDUCATION ASSESSMENT section:

A - Place a check mark in the appropriate box pertaining to the person who was evaluated at the initial education assessment, either Patient or Caregiver (can only assess one person). The Initial Education Assessment must be completed within 24 hours of admission or the first teaching encounter.

B - Place a check mark in the appropriate box(es) that relates best to the patient/caregiver's Learning Style(s).  The choices are:

Audiovisual

Demonstration

Written

Verbal

Group Class

C - Place a check mark in the appropriate box that best describes the patient/caregiver’s Motivation Level. The choices are:

Motivated

Unmotivated

Unable to Assess

D - Indicate a Barrier Code using the Barrier Codes listed at the top of the form. If no barriers are present, you must indicate "N" on the space provided - do not leave blank.

E - Print the name, title and date of the licensed healthcare worker who does the initial assessment in the space provided.

3. Write the date the instruction was given in the space provided.

4. Write your name and title in the space provided.

5. Most education that is provided can be categorized under one of ten (10) items listed under Topics at the top of the MDPEF. In the space provided, write the number of the topic(s) that relates best to the education that was provided.

6. Write either the method(s) of teaching that was utilized or write the codes pertaining to these methods (see Teaching Method codes at the top of the MDPEF).

7. List the educational materials that were used and topics discussed in the space provided. Also use this space to specify how barriers to learning will be addressed if any, other than none, were specified in #2D.

8. Identify the recipient(s) of the teaching in the space provided.

9. Complete this section using the Learner Response codes listed at the top of the MDPEF.

10. Write in the Motivation Level of the patient at the time of the teaching encounter, using the Motivation Level codes at the top of the MDPEF.

11. Indicate the Barriers to Learning at the time of the teaching and how the barriers were addressed, using the Barriers and Addressing Barriers codes at the top of the MDPEF (example: Patient who does not speak English: L/T). If no barriers exist, you must write N/N in the space provided - do not leave blank