HONORHEALTH Military Partnership

Size: px
Start display at page:

Download "HONORHEALTH Military Partnership"

Transcription

1 Annual Tour (AT) Requirements & Prerequisites Checklist (As Of March 2017) HONORHEALTH Military Partnership Scottsdale Osborn Medical Center 7301 E 4 th Street, Suite 1 Lenore Portante Military Partnership Office Supervisor Ph: lenore.portante@honorhealth.com Scottsdale, AZ Roxanne Flynn, RN Military Partnership Clinical Educator Ph:(480) roxanne.flynn@honorhealth.com Hospital Highlights: Honorhealth is a 5-hospital system located in Scottsdale, Arizona. Honorhealth Scottsdale Osborn Medical Center is a 337 bed Level I trauma center with: 4 Trauma Resuscitation Bays, 4 Trauma Observation Beds 11 Trauma Operating Rooms 46 Trauma / Medical Surgical Intensive Care Beds Emergency Department - 55,000 square feet, 38 full-service medical rooms 1 helipad - able to handle 3 air evacuation helicopters or 1 fully loaded Blackhawk Training Capacity: Honorhealth can accept a total of 16 personnel per Annual Tour to include the following: Openings Specialty 8 RNs/medics Total 8 Nurses and/ or Medics 1 4D0 / 68M Dietary Technician 1 4H0 / 68V Cardiopulmonary Technician 1 4J0 Physical Therapy Technician 1 4N1/ 68D Surgical Technician 1 4P0 / 68Q Pharmacy Technician 1 4R0 / 68P Diagnostic Imaging Technician 1 4Y0 / 68E Dental Assistant must be a skill level 5, experience using dental software, X-ray certification (preferred), bilingual English & Spanish (optional), rental car required 1 42B Physical Therapist 1 47G / 63A Dentist AT Monitors/Troop Commanders: We are not able to accommodate service members who have a Limited Duty Condition / Profile Individuals with missing documentation will not be permitted to participate in training with Honorhealth Due 120 days prior to your start date: Annual Tour Training Plan and roster should include the following information on each participant: Name, rank, AFSC/MOS and experience level (related to AFSC/MOS) Civilian job/years of experience (relevant to AFSC/MOS) Due 90 days prior to your start date: REQUIRED Documentation / Licensure: Each unit must transmit the following documentation / licensure requirements for each participant. Please scan and documentation to Lenore Portante at lenore.portante@honorhealth.com. Or fax REQUIRED Licensure / Documentation: o Current BLS / ACLS (if applicable) card for all participants o Current EMT certificate (all medics) o Current RN license (as appropriate) REQUIRED Honorhealth Military Health Form - Infectious Disease Screening & Immunization Status (see page 4) is the mandatory medical clearance form required for each participant. Using this form, each participant will be able to show proof of the required immunizations. DO NOT SEND A SHOT RECORD. o Hepatitis B 3 vaccination series or positive titer o MMR 2 vaccination or positive titer o Varicella 1 vaccination or positive titer

2 o Tdap (within 10 years) o Annual seasonal flu vaccination o TB test (MM/DD/YYYY) Honorhealth requires an annual TB test for ALL medical professionals. See explanation of criteria below If you have been tested annually and can provide evidence of a negative TB test within a year of training dates, no TB test is required If you do not have evidence of a negative TB test within a year of training date, a TB test is required If you have a history of a positive reaction to a TB test, no TB test is required. Documentation of initial negative chest x-ray is required REQUIRED Maricopa Integrated Health System (MIHS) Student Orientation Guidelines and HIPAA form: Each medic/rn must sign and return this 2-page form (pages 5 AND 6). Respirator Fit Test: All attendees must have Respirator Fit Test documented within the past 12 months. Required packing list: Uniforms / Name Tags / Rank Insignia ABUs / ACUs are the required duty uniform for 4 days. (NO Blues required) (Orientation day, 2 trauma lecture days, out processing day) Military name tag (pin on) that will be worn with scrubs (mandatory) Full size rank insignia (pin on) that will be worn with scrubs (mandatory) Comfortable, closed toes and heeled, conservatively colored shoes that will be worn with scrubs ACTIVE DUTY AND NATIONAL GUARD MEMBERS ONLY: You may be scheduled to ride along with Phoenix Fire Department at one of the more than 50 Fire Stations across the Phoenix metro area. Driving distances are between 5-15 miles. Please be prepared to wear an alternate duty uniform to the Phoenix Fire Stations. Your alternate uniform options are: o navy blue or black polo shirt with long or short sleeves (unit logo or other small logo is ok) o navy blue or black heavy work pants or your ABU/ACU pants o work boots or your uniform boots Uniforms / Scrubs / Name Tags / Pin-On Rank / Insignia Orientation Day (Day 1), please report for duty in ABUs / ACUs. Honorhealth supplied scrubs are the duty uniform for clinical shifts. Honorhealth Dress, Grooming and Hygiene policy requires all tattoos to be concealed from view while on duty. If you have a tattoo that is visible while wearing short sleeved scrubs, you are authorized to wear a white, black or light blue long-sleeve shirt under the Honorhealth issued scrubs. Bring comfortable, closed toes and heeled, conservatively colored shoes that will be worn with scrubs Pin on military name tag and rank insignia are mandatory on your scrubs Honorhealth supplied Military Partnership identification badges must be worn at all times while participating in clinical activities Report Date / Time / Location / Out Processing Reporting location 7301 E 4 th Street, Suite 1 Scottsdale, AZ Follow this link to our campus map for parking options: Monday is your reporting date, orientation day and the 1 st day of training Monday s duty uniform is ABUs / ACUs. (NO Blues required) Report NO LATER THAN 0745 Final out processing takes place on the last Friday of Annual Tour and will end no later than 1400 Please plan for return travel NO EARLIER THAN 1500 on the last day of Annual Tour. Shifts/Rules of Engagement Military Partnership clinical shift schedules are in several different departments in order to ensure RSV / critical skills requirements are accomplished. Each participant will have at least 2 days off o Expect to work 8 and 12 hour shifts as well as at least 1 weekend shift 2

3 Lodging Options: We highly recommend staying at one of the local Marriott hotels. The hotels listed below have a lower, government rate available. Please contact Natalie Rene, our Marriott account representative, for the best rates. Natalie.Rene@marriott.com The closest location is Courtyard Scottsdale Old Town, 3311 N Scottsdale Rd, Scottsdale it is literally across the street from the Scottsdale Osborn Medical Center. We recommend this hotel for Annual Tour. Residence Inn Scottsdale Paradise Valley 6040 N Scottsdale Road, Scottsdale is approximately 2 miles north of Scottsdale Osborn Medical Center. This hotel has studio and 2 bedroom suites that can decrease your per diem costs. Each suite has a full kitchen as well as other amenities. Scottsdale Old Town Suites, 7325 E Third Ave, Scottsdale, is approximately 1 mile north of Scottsdale Osborn Medical Center Luke AFB is located in Glendale, AZ, approximately 45 miles west of Scottsdale. Luke AFB billeting is not a viable option for training at Honorhealth Scottsdale Osborn Medical Center. A non-availability letter from Luke AFB billeting is not required for lodging reimbursement. Transportation Phoenix Sky Harbor Airport is the closest airport. Commercial ground transportation is available for travel between the airport and the hotels around Honorhealth Scottsdale Osborn Medical Center. Mil Air: 161 st Refueling Wing, Arizona Air National Guard is based out of Phoenix Sky Harbor airport. Please contact them for additional information on Mil Air options. Rental vehicles are REQUIRED. At least 3 rental vehicles are needed for each 10 participants. Honorhealth Scottsdale Shea Medical Center is approximately 10 miles north of Osborn. Maricopa Integrated Health System (MIHS) is located in downtown Phoenix approximately 10 miles west of Honorhealth Scottsdale Osborn Medical Center. AIR FORCE RESERVE UNITS: A Deployment Review (DR) is required when commercial travel funds or Reserve organic assets are requested. Please see AFRCI or the Annual Training Guide for DR Wing requirements and the submission deadlines. Military Bearing During your time here, remember you are a member of the US Armed Services and subject to regulations regarding appearance, fraternization and behavior. Only natural nails or plain, unchipped polish is permitted Artificial nails of any kind are not permitted We have Air Force Medical Service (AFMS) Headquarters and the National Guard Bureau as well as distinguished civilian visitors. Address fellow team members and faculty by proper military / civilian titles. Exercise good judgment when choosing off duty activities. Any conduct prejudicial to good order and discipline of the Armed Forces will result in the member s immediate return to their unit for action. Meals: Meals are available at the Scottsdale Osborn Medical Center cafeterias as well as other nearby restaurants. Force Protection: Scottsdale Osborn Medical Center is located in an urban setting. Hospital security personnel patrol the premises and appropriate security measures are deployed. Although these measures are important deterrents and protection, crime can and does occur in and around the hospital campus. Military personnel are encouraged to exercise caution and maintain increased awareness of your surroundings. Emergencies Emergent injuries or illnesses will be seen at the Scottsdale Osborn Medical Center or the closest appropriate emergency room. Report any injuries to your home station. For personal or family emergencies, the program participant s unit should initiate and process emergency leave requests through their unit. Immediately notify the Honorhealth Military Partnership administrative staff of any medical, personal or family emergency. Office Equipment and Computers Free Wi-Fi is available throughout the hospital system. Office equipment, including copier, fax and scan to , are available in the Military Partnership office. We have several CAC enabled computers available for official use with printing capabilities. 3

4 Military Health Form - Infectious Disease Screening & Immunization Status NAME: DATE: ALL PARTICIPANTS involved with patient care and activities at Honorhealth Scottsdale Osborn Medical Center, Scottsdale, AZ must have a tuberculin skin test within 12 months of the Annual Tour out processing date. If a participant has had a positive tuberculin test, he/she must provide a negative chest x-ray report. The initial negative report will suffice. In the interest of protecting patients and staff, Honorhealth requires that all Military Partnership Program participants provide this information no later than 90 days before the start date. TB TESTING: Check one of the following: I receive annual tuberculosis skin testing and I am tuberculosis skin test negative Test results from any source are acceptable in order to avoid repeat skin testing. Date of TB test: (Month / Day / Year) Positive PPD, negative chest x-ray, no symptoms suggestive of tuberculosis (answer questions below) Are you currently experiencing? Unexplained productive cough? Yes No Hemoptysis? Yes No Unexplained weight loss or increased fatigue? Yes No Arriving within the last 5 years from a foreign country? Yes No Have any TB associated risk factors? Yes No Have you ever received the BCG vaccine? Yes No IMMUNIZATION STATUS Hepatitis B 3 vaccination series Yes No or Positive Titer Yes No MMR 2 vaccination series Yes No or Positive Titer Yes No Varicella (Chicken Pox) 1 vaccination Yes No or Positive Titer Yes No Tdap booster (w/i 10 years) Yes No I received the annual seasonal flu vaccination on. I certify that is current in all Honorhealth Military Partnership program requirements and is free of communicable diseases including infectious tuberculosis. Signature of Health Care Provider: Health Care Provider STAMP: Date: 4

5 Student s Name (print): Start & End Dates of Clinical Rotation: LEAVE BLANK Student Orientation Guidelines Signature Page Instructor s Name (print): Lenore Portante Honorhealth Military Partnership Supervisor Rotation Type: LEAVE BLANK I verify that I have read and will comply with the stated Student Guidelines: Student s Signature: Military address: Date: Submit Signature Page and Confidentiality Form to the Student Coordinator. 5

6 6

Oregon State University School of Biological and Population Health Sciences KIN 344: Pre-Therapy/Allied Health Practicum.

Oregon State University School of Biological and Population Health Sciences KIN 344: Pre-Therapy/Allied Health Practicum. KIN 344: Pre-Therapy/Allied Health Practicum Checklist Obtain application packet and read all enclosed information Complete the Application Form Complete the Immunization Form Attach copies of medical

More information

Emergency Medical Technician. Student Manual Courses 1119, 1119L and 1431

Emergency Medical Technician. Student Manual Courses 1119, 1119L and 1431 Emergency Medical Technician Student Manual Courses 1119, 1119L and 1431 Course Goals: These courses combined are designed to instruct the student to the level of Emergency Medical Technician, who serves

More information

Middle Tennessee State University School of Nursing Undergraduate Program Clinical Policy

Middle Tennessee State University School of Nursing Undergraduate Program Clinical Policy Middle Tennessee State University School of Nursing Undergraduate Program Clinical Policy The Middle Tennessee State University School of Nursing has one undergraduate degree seeking program. Tracks in

More information

** Clinical Training Requirements Checklist for Conditionally Accepted Allied Health Students**

** Clinical Training Requirements Checklist for Conditionally Accepted Allied Health Students** 1 ** Clinical Training Requirements Checklist for Conditionally Accepted 2016-17 Allied Health Students** The following checklist outlines required documentation for conditionally accepted 2016-17 Allied

More information

MOLLOY COLLEGE THE BARBARA H. HAGAN SCHOOL OF NURSING. CHECKLIST Everything must be completed

MOLLOY COLLEGE THE BARBARA H. HAGAN SCHOOL OF NURSING. CHECKLIST Everything must be completed : MOLLOY COLLEGE CHECKLIST Everything must be completed 1. PHYSICAL EXAMINATION, completed on a School of Nursing Physical Form. Must be signed, stamped and dated by a Health Care Provider and include:

More information

MOLLOY COLLEGE Barbara H. Hagan School of Nursing

MOLLOY COLLEGE Barbara H. Hagan School of Nursing New Clinical Student Checklist MOLLOY COLLEGE Barbara H. Hagan School of Nursing The following is a checklist of requirements for attending clinical practice Hospitals and Community Agencies. Each item

More information

MEDICAL LABORATORY SCIENCE MANDATORIES INFORMATION

MEDICAL LABORATORY SCIENCE MANDATORIES INFORMATION MEDICAL LABORATORY SCIENCE MANDATORIES INFORMATION FIRST YEAR MANDATORIES HIPAA/OSHA Training You will complete your training through the Evolve e Learning Solutions website. You will receive an email

More information

Internship Application x2645

Internship Application x2645 Internship Application 978-683-4000 x2645 Office Use Only Application Received Interview Orientation CORI TB1 TB2 Pin # Entered in Volgistics FLU PERSONAL INFORMATION First Name Last Name Street Address

More information

APP STUDENT CLINICALS APPLICATION

APP STUDENT CLINICALS APPLICATION APP STUDENT CLINICALS APPLICATION Thank you for your interest in performing clinicals at Stillwater Medical Center. Please read the following eligibility and requirements before completing the application.

More information

B. Observation Only Supervised by a school s instructor and/or Valley Children s Hospital preceptor or privileged provider.

B. Observation Only Supervised by a school s instructor and/or Valley Children s Hospital preceptor or privileged provider. Policy/Procedure Number PC-1108 Policy/Procedure Name Clinical Student Program Type of Policy/Procedure Provision of Care - Operations Date Approved 02/14 Date Due for Review 02/17 Policy/Procedure Description

More information

RN Refresher Program Information Packet

RN Refresher Program Information Packet MESA COMMUNITY COLLEGE RN Refresher Program Information Packet 2017-2018 Mesa Community College Nursing Department, Health & Wellness Building #8 (480) 461-7104 Fax (480) 461-7821 NONDISCRIMINATION POLICY

More information

Shadow-a-Professional Program 2016 Application

Shadow-a-Professional Program 2016 Application Thank you for your interest in The Shadow-A-Professional program that allows high school junior and senior students interested in the hospital industry to explore career options and/or gain experience

More information

New Student Information for Licensed Undergraduate Registered Nurse (RN) to Bachelor of Science in Nursing (BSN) Students

New Student Information for Licensed Undergraduate Registered Nurse (RN) to Bachelor of Science in Nursing (BSN) Students New Student Information for Licensed Undergraduate Registered Nurse (RN) to Bachelor of Science in Nursing (BSN) Students 1. Orientation a. New Student Orientation is mandatory for all new undergraduate

More information

Please feel free to contact me at (410) if you have any questions regarding your application. Thanks again for thinking of Sinai Hospital!

Please feel free to contact me at (410) if you have any questions regarding your application. Thanks again for thinking of Sinai Hospital! July 2017 Dear Student, Thank you for your interest in Sinai Hospital s Student Fall Volunteer Program! As a healthcare family dedicated to our community, we are excited to help facilitate your hands-on

More information

DEPN AND GRADUATE NURSING MANDATORIES INFORMATION

DEPN AND GRADUATE NURSING MANDATORIES INFORMATION DEPN AND GRADUATE NURSING MANDATORIES INFORMATION INITIAL MANDATORIES DUE AUGUST 15, 2018 Pre Clinical Mandatories Form If you have a first time positive PPD, include a radiology report If you have a history

More information

EMT-BASIC STUDENT POLICY MANUAL COURSE GUIDE

EMT-BASIC STUDENT POLICY MANUAL COURSE GUIDE EMT-BASIC STUDENT POLICY MANUAL & COURSE GUIDE 2017-2018 TABLE OF CONTENTS: Program Description................................................ 3 Goal Statement....................................................

More information

Patient Care Technician Certificate. Career Talk and Program Requirements

Patient Care Technician Certificate. Career Talk and Program Requirements Patient Care Technician Certificate Career Talk and Program Requirements Welcome to the PCT Career Talk! Completion of this Career Talk is a requirement for all students prior to registration for PCT courses.

More information

Guide to CastleBranch

Guide to CastleBranch Guide to CastleBranch CastleBranch / CB: https://www.castlebranch.com/ Prior to beginning practicum courses, students must provide documentation that they have met certain requirements through CastleBranch,

More information

Student Health Form Howard Community College Health Science Division

Student Health Form Howard Community College Health Science Division Name: HCC ID#: Student Health Form Howard Community College Health Science Division Student- Check program: Nursing: Fall: PN RN Day E/W Spring Accelerated Pathways (NURS-103) CVT: Dental Hygiene: MLT:

More information

** Clinical Training Requirements Checklist for Conditionally Accepted EMS Students**

** Clinical Training Requirements Checklist for Conditionally Accepted EMS Students** 1 ** Clinical Training Requirements Checklist for Conditionally Accepted 2017-18 EMS Students** The following checklist outlines required documentation for conditionally accepted 2016-17 EMS and Paramedic

More information

OWENS COMMUNITY COLLEGE DENTAL ASSISTING CERTIFICATE ORIENTATION

OWENS COMMUNITY COLLEGE DENTAL ASSISTING CERTIFICATE ORIENTATION OWENS COMMUNITY COLLEGE DENTAL ASSISTING CERTIFICATE ORIENTATION CHECKLIST WHAT MUST BE DONE BEFORE STARTING THE DENTAL ASSISTING CERTIFICATE PROGRAM Register as soon as possible and scheduled in the class

More information

IMPORTANT Instructions for Incoming First Semester ADN Students Spring 2018

IMPORTANT Instructions for Incoming First Semester ADN Students Spring 2018 IMPORTANT Instructions for Incoming First Semester ADN Students Spring 2018 Congratulations and welcome to first semester of the ADN Program! My name is Laura DeFreitas. I am course coordinator for first

More information

CRITICAL REQUIREMENTS FAQs Press control and click on the question to follow the link to the answer.

CRITICAL REQUIREMENTS FAQs Press control and click on the question to follow the link to the answer. CRITICAL REQUIREMENTS FAQs Press control and click on the question to follow the link to the answer. Table of Contents 1) What are the changes to the critical requirements?... 3 2) What cohorts are affected?...

More information

BROOKLINE COLLEGE PHYSICAL THERAPIST ASSISTANT PROGRAM APPLICATION REQUIREMENTS

BROOKLINE COLLEGE PHYSICAL THERAPIST ASSISTANT PROGRAM APPLICATION REQUIREMENTS BROOKLINE COLLEGE PHYSICAL THERAPIST ASSISTANT PROGRAM APPLICATION REQUIREMENTS 2017-2018 Lynn E. Bagnull, PT, MBA Program Director lynn.bagnull@brooklinecollege.edu James Mulroy, PT, MS Academic Coordinator

More information

Middle Tennessee State University MSN Program. Clinical/Student Requirements- Admission to MSN Program

Middle Tennessee State University MSN Program. Clinical/Student Requirements- Admission to MSN Program Middle Tennessee State University MSN Program Clinical/Student Requirements- Admission to MSN Program The following are required documents that MUST be uploaded in Medatrax prior to beginning the MSN program.

More information

APPLICATION FOR ADMISSION TO THE EMT-PARAMEDIC PROGRAM FALL 2018

APPLICATION FOR ADMISSION TO THE EMT-PARAMEDIC PROGRAM FALL 2018 APPLICATION FOR ADMISSION TO THE EMT-PARAMEDIC PROGRAM FALL 2018 Pre-Admission Session for Allied Health NAME JC STUDENT ID NUMBER ADDRESS CITY STATE ZIP HOME PHONE CELL PHONE EMAIL ADDRESS The following

More information

Applicant Name: First Middle Last. Age: Birth Date: Applicant Cell Phone: Address Phone: Number & Street Name City Zip Code

Applicant Name: First Middle Last. Age: Birth Date: Applicant Cell Phone: Address Phone: Number & Street Name City Zip Code PLEASE PRINT : Applicant Name: First Middle Last Age: Birth : Applicant Cell Phone: Address Phone: Number & Street Name City Zip Code (Applicant s) E-mail address: / Applicant s Parent s Legal Guardian/Mother/Father

More information

CRAFTON HILLS COLLEGE PARAMEDIC PROGRAM Fall 2016 Application

CRAFTON HILLS COLLEGE PARAMEDIC PROGRAM Fall 2016 Application CRAFTON HILLS COLLEGE PARAMEDIC PROGRAM Fall 2016 Application TO: FROM: Prospective EMT-Paramedic Student Dan Word MSHS, EMT-P Director Paramedic Education SUBJECT: Fall 2016 Paramedic Program (Class 87)

More information

*** Program Guidelines ***

*** Program Guidelines *** *** Program Guidelines *** *The Junior Volunteer program has a limited number of available positions. Placement decisions will be based upon first come, first serve. Volunteers must be at least 15 years

More information

Clinical Education Policies

Clinical Education Policies 1 Clinical Education Policies Table of Contents Assignment of Students Page 1 Student Information Page 1 Student Information Form Page 2 Reasonable Accommodations Request Student Health Form Pages 3-5

More information

MCC Mohave NURSING ASSISTANT CERTIFICATE PROGRAM STUDENT HANDBOOK. Community College Revised: 9/2017; 11/28/17

MCC Mohave NURSING ASSISTANT CERTIFICATE PROGRAM STUDENT HANDBOOK. Community College Revised: 9/2017; 11/28/17 MCC Mohave Community College NURSING ASSISTANT CERTIFICATE 2017-2018 PROGRAM STUDENT HANDBOOK Revised: 9/2017; 11/28/17 0 PROGRAM DESCRIPTION The Nursing Assistant Certificate Program (NAP) provides an

More information

Santa Rosa Junior College Health Sciences Department Health Evaluation Form. STUDENT NAME: Last First MI BIRTHDATE: SRJC ID # GENDER: M F

Santa Rosa Junior College Health Sciences Department Health Evaluation Form. STUDENT NAME: Last First MI BIRTHDATE: SRJC ID # GENDER: M F Santa Rosa Junior College Health Sciences Department Health Evaluation Form STUDENT NAME: Last First MI BIRTHDATE: SRJC ID # GENDER: M F ADDRESS: Street City State Zip Code Home Phone ( ) - Mobile Phone

More information

Middle Tennessee State University MSN Program. Clinical/Student Requirements- Admission to MSN Program

Middle Tennessee State University MSN Program. Clinical/Student Requirements- Admission to MSN Program Middle Tennessee State University MSN Program Clinical/Student Requirements- Admission to MSN Program The following are required documents that MUST be uploaded in Medatrax prior to beginning the MSN program.

More information

Cherokee Nation W. W. Hastings Hospital Surgical Technology Program Application Booklet

Cherokee Nation W. W. Hastings Hospital Surgical Technology Program Application Booklet Cherokee Nation W. W. Hastings Hospital Surgical Technology Program Application Booklet Dear Prospective Student: Thank you for your interest in Cherokee Nation W. W. Hastings Hospital Surgical Technology

More information

JOHNS HOPKINS SCHOOL OF NURSING PRE-ENTRANCE HEALTH FORM

JOHNS HOPKINS SCHOOL OF NURSING PRE-ENTRANCE HEALTH FORM JOHNS HOPKINS SCHOOL OF NURSING PRE-ENTRANCE HEALTH FORM Master s Entry into Nursing MSN Advanced Practice MSN/MPH Post Graduate Certificate DNP Advanced Practice DNP Executive PhD CHECK ( ) PROGRAM OF

More information

Student Health Form Howard Community College Health Science Division

Student Health Form Howard Community College Health Science Division Name: HCC ID#: Student Health Form Howard Community College Health Science Division HEALTH FORM DEADLINES Completed Health Form must be submitted prior to the following dates. Late submissions may result

More information

Hello! We wish you all the best in your endeavors.

Hello! We wish you all the best in your endeavors. Hello! Thank you for your interest in Student Education at Maricopa Integrated Health System. We believe our facilities will provide you with outstanding educational opportunities in a student-friendly

More information

Job Shadow Program Guidelines

Job Shadow Program Guidelines Job Shadow Program Guidelines The Job Shadow Program is intended for those who have an interest in learning more about health care professions. Shadowing allows the participant to follow and observe a

More information

NURSING ASSISTANT ADVANCED PLACEMENT PROGRAM REGISTRATION PACKET AND INFORMATION

NURSING ASSISTANT ADVANCED PLACEMENT PROGRAM REGISTRATION PACKET AND INFORMATION NURSING ASSISTANT ADVANCED PLACEMENT PROGRAM REGISTRATION PACKET AND INFORMATION Classes are offered at the following locations: Superstition Mountain Campus Signal Peak Campus Maricopa Campus San Tan

More information

Allan Hancock College 2019 Licensed Vocational Nursing Program Application Period: April 1 st June 30 th, 2018

Allan Hancock College 2019 Licensed Vocational Nursing Program Application Period: April 1 st June 30 th, 2018 *This application is for applicants who currently have an LVN waitlist number* It is the responsibility of the student to complete this application packet and turn it into the Health Sciences Department

More information

NURSING STUDENT HEALTH & IMMUNIZATION RECORDS

NURSING STUDENT HEALTH & IMMUNIZATION RECORDS NURSING STUDENT HEALTH & IMMUNIZATION RECORDS *********************************** COMPLETE THE ATTACHED HEALTH PACKET AND SUBMIT TO THE NURSING DEPARTMENT NO LATER THAN THE ASN ORIENTATION. **************************************

More information

Middle Tennessee State University Master of Science in Nursing Health History and Physical Examination Form

Middle Tennessee State University Master of Science in Nursing Health History and Physical Examination Form 1 Middle Tennessee State University Master of Science in Nursing Health History and Physical Examination Form HEALTH HISTORY To be completed by student and/or health care provider include immunization

More information

THIRD PARTY RIDE-A-LONG PROGRAM

THIRD PARTY RIDE-A-LONG PROGRAM General Conduct The conduct of a rider will reflect upon the individual, the responding agency, other cooperating agencies and the program in which the rider is associated with. Each rider is required

More information

BINGHAMTON UNIVERSITY DECKER SCHOOL OF NURSING Student Health Requirements

BINGHAMTON UNIVERSITY DECKER SCHOOL OF NURSING Student Health Requirements BINGHAMTON UNIVERSITY DECKER SCHOOL OF NURSING Student Health Requirements This document includes information regarding: Student health evaluation form Documentation of immunity to communicable diseases

More information

SECOND SEMESTER INSTRUCTIONS FOR INCOMING TRANSFER / LVN ADN STUDENTS Fall 2018

SECOND SEMESTER INSTRUCTIONS FOR INCOMING TRANSFER / LVN ADN STUDENTS Fall 2018 SECOND SEMESTER INSTRUCTIONS FOR INCOMING TRANSFER / LVN ADN STUDENTS Fall 2018 DECLARATION OF INTENT: Please read and sign the Declaration of Intent form indicating your decision to accept a place in

More information

Hands that serve.hearts that care.

Hands that serve.hearts that care. Hands that serve.hearts that care. Dear Applicant, We are excited that you are interested in volunteering at The University of Mississippi Medical Center (UMMC) and we want to make your volunteering experience

More information

MSU-Crowder Bachelor of Science in Nursing (BSN-C) Scholars Program.

MSU-Crowder Bachelor of Science in Nursing (BSN-C) Scholars Program. Dear Prospective Student: Thank you for your inquiry regarding the MSU-Crowder Bachelor of Science in Nursing (BSN-C) Scholars Program. This program is the result of an exciting collaboration between Crowder

More information

Nurse Assistant Training Program National Capital Region, Alexandria, Virginia Nurse Assistant Training Program MISSION STATEMENT

Nurse Assistant Training Program National Capital Region, Alexandria, Virginia Nurse Assistant Training Program MISSION STATEMENT Nurse Assistant Training Program - 2016 National Capital Region, Alexandria, Virginia Nurse Assistant Training Program The American Red Cross Nurse Assistant Training Program meets the Virginia Board of

More information

OBSERVER APPLICATION

OBSERVER APPLICATION OBSERVER APPLICATION Application Instructions: Please type all responses. Review and complete the application and required attachments following the application. A submission checklist is provided to ensure

More information

ATHLETIC TRAINING MANDATORIES INFORMATION

ATHLETIC TRAINING MANDATORIES INFORMATION ATHLETIC TRAINING MANDATORIES INFORMATION FIRST YEAR MANDATORIES (DUE DATE WILL BE ANNOUNCED IN CLASS) HIPAA/OSHA Training You will complete your training through the Evolve e-learning Solutions website.

More information

Nursing Assistant Program

Nursing Assistant Program Nursing Assistant Program Chaffey Nursing Assistant Program Chaffey College does not certify nursing assistants, they prepare the student for certification. Students must successfully pass this course

More information

Health records are entered and stored on Verified Credentials website. Be prepared to pay a one time access fee! (Credit card

Health records are entered and stored on Verified Credentials website. Be prepared to pay a one time access fee! (Credit card 11/21/2017 1 Verified Credentials Health records are entered and stored on Verified Credentials website. Be prepared to pay a one time access fee! (Credit card or PayPal) Health requirements are determined

More information

ATHLETIC TRAINING MANDATORIES INFORMATION

ATHLETIC TRAINING MANDATORIES INFORMATION ATHLETIC TRAINING MANDATORIES INFORMATION FIRST YEAR MANDATORIES (DUE DATE WILL BE ANNOUNCED IN CLASS) HIPAA/OSHA Training You will complete your training through the Evolve e-learning Solutions website.

More information

NURSING ASSISTANT PROGRAM REGISTRATION PACKET AND INFORMATION

NURSING ASSISTANT PROGRAM REGISTRATION PACKET AND INFORMATION NURSING ASSISTANT PROGRAM REGISTRATION PACKET AND INFORMATION Must be received 10 days prior to the start of class to be admitted for the semester. Classes are offered at the following locations: Superstition

More information

ADN Program Application Packet

ADN Program Application Packet ADN Program Application Packet New Associate Degree Nursing (ADN) students are admitted each Spring and Fall semester. Space in the ADN program is limited; therefore, admission is competitive and applicants

More information

HEALTH REQUIREMENTS AND OTHER DOCUMENTATION Required for RN Mobility Students

HEALTH REQUIREMENTS AND OTHER DOCUMENTATION Required for RN Mobility Students HEALTH REQUIREMENTS AND OTHER DOCUMENTATION Required for RN Mobility Students 1. Health and physical exam form (Form 1) 2. Student Immunization form requiring verification of completed immunizations (Form

More information

STUDENT NAME: Date Completed:

STUDENT NAME: Date Completed: WINONA STATE UNIVERSITY College of Nursing and Health Sciences Graduate Programs in Nursing HEALTH INFORMATION AND REQUIREMENTS FOR PARTICIPATION IN THE GRADUATE PROGRAMS IN NURSING STUDENT NAME: Date

More information

VILLANOVA UNIVERSITY COLLEGE OF NURSING GRADUATE PROGRAM DIRECTIONS TO COMPLETING PRACTICUM APPLICATION

VILLANOVA UNIVERSITY COLLEGE OF NURSING GRADUATE PROGRAM DIRECTIONS TO COMPLETING PRACTICUM APPLICATION VILLANOVA UNIVERSITY GRADUATE PROGRAM DIRECTIONS TO COMPLETING PRACTICUM APPLICATION DUE DATE Dates for submission of Practicum applications vary depending on the semester in which you plan to enroll in

More information

CLINICAL EXPERIENCES DEPARTMENT OF PHYSICAL THERAPY

CLINICAL EXPERIENCES DEPARTMENT OF PHYSICAL THERAPY CLINICAL EXPERIENCES DEPARTMENT OF PHYSICAL THERAPY 2 TABLE OF CONTENTS Clinical Experiences... 3 Clinical Experiences 2nd Year... 3 Clinical Experiences 3rd Year... 3 Clinical Site Selection... 4 Assignments...

More information

Marian University Leighton School of Nursing-Bachelor of Science in Nursing Program Clinical Application-Spring 2017 CAMPUS BASED ACCELERATED

Marian University Leighton School of Nursing-Bachelor of Science in Nursing Program Clinical Application-Spring 2017 CAMPUS BASED ACCELERATED Marian University Leighton School of Nursing-Bachelor of Science in Nursing Program Clinical Application-Spring 2017 CAMPUS BASED ACCELERATED Only completed applications will be accepted in the Nursing

More information

University of South Alabama College of Nursing Bachelor of Science in Nursing

University of South Alabama College of Nursing Bachelor of Science in Nursing ADMISSIONS POLICY Enrollment into the University (pre-professional component) as a nursing major does not assure the student admission to the Professional Component. Enrollment in the Professional Component

More information

Kimberly Harris. Dear Prospective Student Volunteer:

Kimberly Harris. Dear Prospective Student Volunteer: Dear Prospective Student Volunteer: Thanks for your interest in our summer volunteer program at Baylor Scott & White Medical Center White Rock. As a volunteer, you will be providing services and support

More information

Nurse Aide. We reserve the right to cancel any class due to insufficient enrollment.

Nurse Aide. We reserve the right to cancel any class due to insufficient enrollment. Nurse Aide We reserve the right to cancel any class due to insufficient enrollment. **All clinical dates may vary according to site and instructor availability ABOUT THE NURSE AIDE PROGRAM The Nurse Aide

More information

HEALTH PROFESSIONS PROGRAM Physical Examination Form

HEALTH PROFESSIONS PROGRAM Physical Examination Form TIDEWATER COMMUNITY COLLEGE HEALTH PROFESSIONS PROGRAM Physical Examination Form Diagnostic Medical Sonography Emergency Medical Services Health Information Management Medical Laboratory Technology Occupational

More information

Physical & Occupational Therapy Services Clinical Education

Physical & Occupational Therapy Services Clinical Education Massachusetts General Hospital Physical and Occupational Therapy Services Policy & Procedure Manual Title: Physical & Occupational Therapy Services Policy: 600.014 Clinical Education Source: Physical &

More information

COLUMBUS STATE COMMUNITY COLLEGE Dental Hygiene

COLUMBUS STATE COMMUNITY COLLEGE Dental Hygiene 1 Dental Hygiene HEALTH HISTY To be completed by the Student: PLEASE PRINT ALL INFMATION COUGAR I.D. Name: SS#: Last First Middle Address: Street City State Zip Date of Birth: Phone: Month/Day/Year Home

More information

What you need to know. ADN / BSN Concurrent Enrollment Program (CEP) Revised 06/01/2016

What you need to know. ADN / BSN Concurrent Enrollment Program (CEP) Revised 06/01/2016 Working together to provide Associate and Baccalaureate Degrees in Nursing What you need to know ADN / BSN Concurrent Enrollment Program (CEP) Revised 06/01/2016 Revised 6/10/15 INTRODUCTION The Pima Community

More information

SOUTHWESTERN MICHIGAN COLLEGE NURSING PROGRAM

SOUTHWESTERN MICHIGAN COLLEGE NURSING PROGRAM Office Use Only Date Submitted to Nursing Office SOUTHWESTERN MICHIGAN COLLEGE NURSING PROGRAM Application to Begin the Nursing Program Complete and return to the Nursing Department Electronic signatures

More information

Clinical Affiliation with Schools of Nursing Standards

Clinical Affiliation with Schools of Nursing Standards Clinical Affiliation with Schools of Nursing Standards AS-02 I. Purpose: To outline the standards applicable to schools of nursing who affiliate with The Children s Mercy Hospital (CMH). II. Policy: A.

More information

Medical Assistant Training Program Checklist and Application. Student Name: Campus Requested:

Medical Assistant Training Program Checklist and Application. Student Name: Campus Requested: Medical Assistant Training Program Checklist and Application Student Name: Campus Requested: Thank you for your interest in our Medical Assistant Training Program! Please check the last page of this application

More information

BON SECOURS DEPAUL MEDICAL CENTER

BON SECOURS DEPAUL MEDICAL CENTER BON SECOURS DEPAUL MEDICAL CENTER 150 Kingsley Lane, Norfolk Virginia 23505 Main Number: 757-889-5000 Volunteer Office: 757-889-5340 VOLUNTEER SERVICES Orientation Agenda I. Welcome II. Objective TO BE

More information

Applicant Name (Please print) Last First MI. Northeast State Community College assigned Student ID Number: City: State: Zip Code:

Applicant Name (Please print) Last First MI. Northeast State Community College assigned Student ID Number: City: State: Zip Code: Applicant Information (Please note application must be completed in ink.) Applicant Name (Please print) Last First MI Northeast State Community College assigned Student ID Number: Street Address: PO Box:

More information

HUNTINGTON MEMORIAL HOSPITAL CLINICAL POLICY & PROCEDURE

HUNTINGTON MEMORIAL HOSPITAL CLINICAL POLICY & PROCEDURE HUNTINGTON MEMORIAL HOSPITAL CLINICAL POLICY & PROCEDURE SUBJECT: SCHOOLS OF NURSING AUTHORIZED APPROVAL: PURPOSE: POLICY NO.: 8740.144 EFFECTIVE DATE: 6/16 Page 1 of 9 SUPERCEDES/ REPLACES: 5/13 This

More information

Training Opportunity!

Training Opportunity! Training Opportunity! Certified Nursing Assistant (CNA) & Home Health Aide (HHA) Certified Nursing Assistant & Home Health Aide Training is an excellent training opportunity for individuals interested

More information

RUTGERS SCHOOL OF NURSING - CAMDEN STUDENT HEALTH RECORDS PACKET

RUTGERS SCHOOL OF NURSING - CAMDEN STUDENT HEALTH RECORDS PACKET School of Nursing-Camden Rutgers, The State University of New Jersey Residence Hall 215 North 3 rd Street Camden, NJ 08102-1405 nursing.camden.rutgers.edu nursecam@camden.rutgers.edu Phone: 856-225-6226

More information

Ambassador Program Application Packet

Ambassador Program Application Packet Ambassador Program Application Packet Thank you for your interest in becoming an Ambassador at Centinela Hospital Medical Center. Please complete the attached forms and then contact the Centinela Hospital

More information

Clinical Pre-Placement Health Form

Clinical Pre-Placement Health Form Clinical Pre-Placement Health Form Program Name : Practical Nursing-IEN Fast Track Due Program Code (#) 9352 Program Year Program Descriptor Fast Track Student Last Name: Student First Name: Student I.D.

More information

Green River Student ID:

Green River Student ID: STUDENT INFORMATION Email: Green River Student ID: Phone: BEFORE YOU TURN IN THE APPLICATION q Attend a Required Admission Meeting. This is different from the Information Sessions put on by advising staff.

More information

If you would like to volunteer in the Gift Shop as part of the Hospital Auxiliary, please call for additional information.

If you would like to volunteer in the Gift Shop as part of the Hospital Auxiliary, please call for additional information. Dear Prospective Volunteer. Thank you for your interest in the volunteer program at Robert Wood Johnson University Hospital Rahway. We are happy to know that you are considering becoming a part of the

More information

POLICY TITLE: STUDENT CLINICAL REQUIREMENTS PART ONE

POLICY TITLE: STUDENT CLINICAL REQUIREMENTS PART ONE Page 1 of 6 STUDENT CLINICAL REQUIREMENTS PART ONE Policy Number: S101 POLICY TITLE: STUDENT CLINICAL REQUIREMENTS PART ONE The College of Nursing (CON) is committed to ensuring that all nursing students

More information

Health & Safety Packet for Incoming Students

Health & Safety Packet for Incoming Students Health Occupations Division 707-256-7600 Health & Safety Packet for Incoming Students This packet has been designed to help Health Occupations students comply with CPR and health/physical documentation

More information

WELCOME TO THE ASSOCIATE OF SCIENCE IN NURSING ORIENTATION

WELCOME TO THE ASSOCIATE OF SCIENCE IN NURSING ORIENTATION WELCOME TO THE ASSOCIATE OF SCIENCE IN NURSING ORIENTATION SUMMER 2016 FRESHMAN ASN ORIENTATION SUMMER 2016 IMPORTANT INFORMATION & DATES Please make arrangements to complete and submit the information

More information

Dear Volunteen Applicant:

Dear Volunteen Applicant: Dear Volunteen Applicant: Thank you for your interest in volunteering at Marian Regional Medical Center. Our Volunteen Program is for current high school students who are at least 14 years old. Please

More information

DMACC INSTRUCTIONS FOR COMPLETING STUDENT HEALTH AND IMMUNIZATION RECORD

DMACC INSTRUCTIONS FOR COMPLETING STUDENT HEALTH AND IMMUNIZATION RECORD DMACC DES MOINES AREA COMMUNITY COLLEGE INSTRUCTIONS FOR COMPLETING STUDENT HEALTH AND IMMUNIZATION RECORD Health and Public Service Department Students need to complete and submit the Student Health and

More information

Professional Image. Definitions None

Professional Image. Definitions None Professional Image Document Owner: O'Connell, Tim Version: 1 Effective Date: 04/25/2013 Revision Date: 04/25/2016 Approvers: Thompson, Angela Department: Human Resources I. Purpose It is incumbent on each

More information

Date: Name: (Last) (First) (Middle) Address: (Street) (City) (State) (Zip Code) Current Age: Date of Birth: Phone: cell:

Date: Name: (Last) (First) (Middle) Address: (Street) (City) (State) (Zip Code) Current Age: Date of Birth: Phone: cell: Children s Hospital Junior Ambassador Program Application Packet for Summer 2018 Dates of Program June 11th through July 27th, 2018 Application Deadline March 5, 2018 Date: Name: (Last) (First) (Middle)

More information

ALLIED HEALTH INFORMATION PACKET

ALLIED HEALTH INFORMATION PACKET ALLIED HEALTH INFORMATION PACKET Allied Health Intent Form (please return) Nursing Requirements Point System/Course Check Offs Estimated Program Costs C.N.A. Application Contact Information Allied Health

More information

PROCEDURE: 1. Prospective students are required to obtain the Pre-Entrance Physical Examination Form from the Nursing Program office.

PROCEDURE: 1. Prospective students are required to obtain the Pre-Entrance Physical Examination Form from the Nursing Program office. Policy # S-11 POLICY: PRE-ENTRANCE PHYSICAL EXAM POLICY: It is the Policy of the at the University of Pittsburgh at Titusville to require students seeking admission to the to submit documentation of a

More information

Le Bonheur Children's Hospital Child Life Clinical Internship Program

Le Bonheur Children's Hospital Child Life Clinical Internship Program Le Bonheur Children's Hospital Child Life Clinical Internship Program The child life clinical internship is a concentrated 16-week (640 hours) placement within the health care system where qualified students

More information

Grace Health Career Center, LLC. Certified Nurse Aide Application & Registration Information

Grace Health Career Center, LLC. Certified Nurse Aide Application & Registration Information Certified Nurse Aide Application & Registration Information Congratulations on taking the first step towards a new career!! We are excited you have decided to train with GHCC. This packet provides all

More information

Concordia University Nursing Program - Admissions Next Steps

Concordia University Nursing Program - Admissions Next Steps After admission and acceptance, the following steps must be completed and satisfied as noted prior to registration and enrollment in NUR courses. A student may register and enroll in a non-nursing course

More information

Dept and Nbr: HLC 122 Title: HEALTH CAREERS ACAD II Full Title: Health Careers Academy II Last Reviewed: 2/22/2016

Dept and Nbr: HLC 122 Title: HEALTH CAREERS ACAD II Full Title: Health Careers Academy II Last Reviewed: 2/22/2016 3/8/2016 10:11 AM Approved New Course (First Version) HLC 122 Course Outline as of Fall 2016 CATALOG INFORMATION Dept and Nbr: HLC 122 Title: HEALTH CAREERS ACAD II Full Title: Health Careers Academy II

More information

CNA CERTIFICATE PROGRAM APPLICATION PACKET

CNA CERTIFICATE PROGRAM APPLICATION PACKET CNA CERTIFICATE PROGRAM APPLICATION PACKET Application Instructions Thank you for your interest in the Certified Nursing Assistant Certificate Program at the College of Continuing and Professional Education

More information

ALLIED HEALTH INFORMATION PACKET

ALLIED HEALTH INFORMATION PACKET ALLIED HEALTH INFORMATION PACKET Allied Health Intent Form (please return) Nursing Requirements Point System/Course Check Offs Estimated Program Costs C.N.A. Application Contact Information Allied Health

More information

Health Requirements for Students. Updated 1/23/18

Health Requirements for Students. Updated 1/23/18 Health Requirements for Students Updated 1/23/18 1 Health Requirements Table of Contents Health Requirements for Students... 3 Instructions on Getting Started... 4 Instructions on Uploading Documents...

More information

Rappahannock EMS Council

Rappahannock EMS Council Rappahannock EMS Council Regional Training AND simulation center ALS Certification Programs Information 1 Dear Prospective ALS Student: Thank you for your interest in an ALS Certification Program at the

More information

WESTERN CONNECTICUT STATE UNIVERSITY. Master of Science in Nursing GUIDELINES FOR CLINICAL COURSES

WESTERN CONNECTICUT STATE UNIVERSITY. Master of Science in Nursing GUIDELINES FOR CLINICAL COURSES Specific Policies for Students in Clinical Facilities WESTERN CONNECTICUT STATE UNIVERSITY Master of Science in Nursing GUIDELINES FOR CLINICAL COURSES 1. Professional apparel that meets agency guidelines

More information

Sexual Assault Nurse Examiner Job Description

Sexual Assault Nurse Examiner Job Description Sexual Assault Nurse Examiner Job Description Job Title: Forensic Examiner/SANE Reports to: Executive Director Functions Summary: A SANE provides timely and accurate medical assessments and injury identification/documentation

More information

Monday, July 23, 2018*

Monday, July 23, 2018* The Department of Nursing and Health Sciences requires that students registered in the BN program complete the following by: Monday, July 23, 2018* To be completed by First Year students: Register for

More information

Le Bonheur Children's Hospital Child Life Clinical Internship Program

Le Bonheur Children's Hospital Child Life Clinical Internship Program Le Bonheur Children's Hospital Child Life Clinical Internship Program The child life clinical internship is a concentrated 16-week (640 hours) placement within the health care system where qualified students

More information