Nurse Aide Certification Program and/or Part of the Patient Care Technician Program Registration Packet

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1 Brookhaven College Workforce and Continuing Education Division COVER SHEET Prepare for the nurse aide certification examination with this course addressing both written and clinical skills required for those that are or plan to be long-term-care nursing assistants. Successful completion of this course is a prerequisite to taking the state exam for certification to work as a nurse aide. The course content encompasses 100 hours of instruction, 60 hours of lecture and lab and 40 hours of clinical practice. Students do not need previous nursing home experience or to be currently employed to take this course. Note: This course may be taken as a stand-alone course or as part of the. Your registration packet includes the following: 1. Nurse Aide Certification Program and Cover Sheet 2. Nurse Aide Certification Program and Requirements Sheet 3. Drug Screens and Criminal Background Check Sheet 4. Nurse Aide Certification Program and Student Checklist 5. Nurse Aide Registry (NAR) Form 6. Brookhaven College Continuing Education-Immunization Record Form 7. Dallas County Community College District, Workforce and Continuing Education Registration Form Helpful Information Step 1 Please take your immunization records to our Health Center located inside the Student Services Center, Building S, Room S072. The Brookhaven College nurse MUST complete the Immunization Record form before you can register for this program. If you are missing any immunizations, ask the nurse for a list of shots for which she can assist you. TITER tests can be taken to confirm that you have the required immunizations. The Brookhaven College Health Center offers two different Hepatitis series. The most common one requiring up to six months to complete or the TWINRIX series that can be completed within 21 days. Step 2 Once the Immunization Record has been completed and signed, take all required documentation (see student checklist) to the Health Careers office located in Building W, Room W109. The office hours are 8 a.m.-5 p.m., Monday-Thursday and 8 a.m.-4:30 p.m. on Friday. No appointment is necessary. A representative will review and approve your documentation. You will receive a completed Registration Permission Slip. Step 3 Take the Registration Permission Slip and DCCCD, Continuing/Workforce Education Registration Form to the Admissions Office located in Building S, to register for your classes. Step 4 Take your receipt to the Cashier s window to pay for your courses. Payment is due at the time of registration. Note: Liability Insurance MUST be paid at the time of registration. Drug Screenings and Criminal Background Check required to be completed no more than 30 days before the start of the clinical experience. Students MUST provide their own personal healthcare insurance coverage prior to registering, which covers all dates this class meets Driver s license, Passport or State/Military issued ID card is required. (You will be required to present one of these forms of ID at the time you take the State of Texas Nurse Aide Certification Exam.) Social Security Card Will also be required at the time you take the State of Texas Nurse Aide Certification Exam. The clinical component for all Nurse Aide Certification classes meets the last two weeks of class. For additional information about the Nurse Aide Certification Program or please call Susana Ruelas at

2 REQUIREMENTS Nurse Aide Certification (NURA-1001) 60 hours Nurse Aide Clinical (NURA-1060) 40 hours Total 100 hours Course prerequisites MUST be completed prior to registration. Upon successful completion of this program, the student is eligible to take the State of Texas Nurse Aide Certification exam. Course Prerequisites Registration must be done in person. Ability to lift 50 lbs. Nurse Aide Registry (NAR) Form, completed and signed. All applicants must be checked for listing on the Nurse Aide Registry prior to admission. Brookhaven College Continuing Education-Immunization Record Form Brookhaven College will require a copy of proof of immunization. Immunizations must be current. The Immunization Record must be completed and signed ONLY by Brookhaven College s Health Center nurse. The student must provide proof of immunization and complete a Brookhaven College Continuing Education-Immunization Record Form. The following immunizations are required: Measles, Mumps, Rubella (MMR), Varicella, TD or TDAP, all 3 doses of the Hepatitis B series, Flu Shot, and a current TB test (within the last year). If students have had a previous positive PPD test, documentation or history of treatment is required. A copy of current completion card of Basic Cardiac Life Support, BCLS, for Health Care Providers A copy of personal healthcare insurance coverage card A copy of valid U.S. or Texas State Government Issued Photo I.D. (e.g. driver s license) Pass a criminal background check and drug screens* (Students accepted into the Brookhaven College Workforce and Continuing Education Health Programs are required by the Dallas-Fort Worth Hospital Council Member Facilities to undergo a criminal background check and drug screening prior to beginning their clinical experience. These checks must be completed no more than 30 days before the start of the clinical experience.) Students who do not pass these two requirements will not be allowed to continue on to clinicals. Dallas County Community College District, Continuing /Workforce Education Registration Form Social Security Card- Will also be required at the time you take the State of Texas Nurse Aide Certification Exam The clinical component for all Nurse Aide Certification classes meets the last two weeks of class. The following are not included in the cost of the Nurse Aide Certification Program and are the responsibility of the student. Textbooks State of Texas Nurse Aide Certification exam Liability insurance (MUST be paid at the time of registration) Personal healthcare insurance coverage Drug Screens and Criminal Background check Uniform (scrubs, royal blue) Watch with second hand

3 DRUG SCREENS AND CRIMINAL BACKGROUND CHECK Drug Screens The Brookhaven College WCE and/or a clinical agency reserve the right to remove a student from the classroom or clinical facility for suspicion of drug or alcohol use and to submit to a drug and alcohol screen at the student s expense. Additionally, the college and/or clinical agency reserve the right to request that a student submit to a drug and alcohol screen at random at the student s expense. Students with a positive drug screen without an authorized provider prescription or a positive alcohol screen will be removed from Brookhaven College WCE Health Program. Failure to comply with a drug screen request from Brookhaven or one of its clinical agencies will result in the student s immediate expulsion from the Brookhaven College. Furthermore, regardless of testing or testing results, clinical agencies reserve the right to expel students from their facilities. The drug screen follows National Institute on Drug Abuse guidelines and screens for 10 substances, as designated in the Substance Abuse Panel 10, SAP 10. These substances are: amphetamines, barbiturates, benzodiazepines, cocaine metabolites, alcohol, marijuana metabolites, methadone, opiates, phencyclidine and propoxyphene. SAP 10 test results that fall outside of any of the acceptable ranges are considered positive test results and are automatically sent for a separate confirmatory test by a gas chromatography mass spectrometry method. If these results are positive, the test results are sent to a medical review officer who will review the results at an additional cost to the student. The medical review officer will then contact the student to determine if there is a valid prescription for the drug in question. If a valid prescription exists and is verified, the test result will be deemed negative and acceptable. An individual with a positive drug screen will not be allowed to enroll in any health-related continuing education courses for a minimum of 12 months according to the Community Standard. Prior to enrolling or returning to the clinical agency/rotation, a student must provide proof of a negative drug screen as verified by the college/school. Failure to comply with this policy will result in disciplinary action and dismissal from the Brookhaven College. Criminal Background Check The criminal background check reviews a person s criminal history at least seven years prior to the date of program application. The check will include all cities and counties of the person s residency during that time period. The following histories will disqualify an individual from consideration for a clinical rotation: felony convictions; misdemeanor convictions or felony deferred adjudications involving crimes against persons, e.g. physical or sexual abuse; misdemeanor convictions related to moral turpitude, e.g. prostitution, public lewdness/exposure, etc.; felony deferred adjudications for the sale, possession, distribution or transfer of narcotics or controlled substances; or status as a registered sex offender.

4 STUDENT CHECKLIST All forms in this packet must be completed and approved prior to registration. Last Name First Name Course and Section Number Semester Please bring the following documentation to the Brookhaven College Workforce and Continuing Education Health Careers office. The Health Careers office is located in Building W, Room W109. Business hours are Monday Thursday, 8 a.m. - 5 p.m. and Friday, 8 a.m. 4:30 p.m. No appointment is necessary. 0 Brookhaven College Continuing Education-Immunization Record Form 0 A copy of current Basic Cardiac Life Support, BCLS, for Health Care Providers completion card 0 A copy of valid U.S. or Texas State Government Issued Photo I.D. (e.g. driver s license) 0 A copy of current personal healthcare insurance coverage card 0 U.S. or Texas State Government Issued Photo I.D. (e.g. driver s license) 0 Dallas County Community College District, Continuing /Workforce Education Registration Form 0 Nurse Aide Registry Form, completed and signed For WCE Health Careers Office Use Only: Registration Permission Slip approved by: Date: Time: (Signature)

5 and/or Part of NURSE AIDE REGISTRY FORM All applicants must be checked for listing on the Nurse Aide Registry, NAR, prior to admission. Pursuant to 42 code of Federal Regulation (CFR) (1) (ii), nurse aides with a finding of abuse, neglect, or misappropriation of resident s property are prohibited from employment in nursing and skilled nursing facilities. In addition 42 CFR (c)(4)(d) mandates that all findings of abuse, neglect, or misappropriation of resident s property remain on the registry permanently. In order to determine if an individual is listed on the Nurse Aide Registry as UNEMPLOYABLE due to abuse, neglect or misappropriation of resident s property, please call the departments toll-free voice information system at To Be Filled Out By Applicant: Full Name Social Security Number - - Have you ever been certified as a Nurse Aide in Texas? If yes, when? What name was on the certificate? I certify that the information provided in the above application is true and correct. I understand that false information on this application may result in immediate suspension or removal from the course with no refund. Signature of Applicant Date ************************************* To Be Filled Out By Brookhaven College Representative Nurse Aide Registry checked? Yes No Results: Signature of Brookhaven College Representative / Date