Educational Clinical Rules

EDUCATIONAL CLINICAL RULES

Student Information

Date of Birth:   Program:   Level/Year:

Phone:   Email:

Emergency & Medical

Relationship:   Phone:

Clinical Assignment Details

Preceptor / Supervisor:   Course Code:

Clinical Start Date:   Clinical End Date:   Expected Weekly Hours:

Clearance & Documentation Checklist

Proof of required immunizations submitted   Date:

TB screening (PPD or IGRA) current   Date:

Criminal background check completed and cleared   Date:

Drug screening completed and cleared   Date:

Current CPR/BLS certification on file   Expiration:

HIPAA/confidentiality training completed   Date:

Proof of professional liability insurance (if required)   Date:

Rules, Responsibilities, and Legal Provisions

1. Confidentiality and Protected Health Information: The student must maintain strict confidentiality regarding patient information at all times. The student acknowledges that unauthorized use or disclosure of patient information may result in disciplinary action, removal from the clinical site, and potential civil or criminal liability. The student will comply with all facility and professional confidentiality rules and complete any required privacy training prior to clinical participation.

2. Professional Conduct and Scope of Practice: Students shall adhere to standards of professional conduct, maintain appropriate boundaries, and perform only tasks for which they have been trained and authorized. Delegation by preceptors does not expand a student's scope beyond educational competencies and applicable statutes or regulations. Failure to comply with professional standards may result in immediate removal from the clinical environment and academic sanction.

3. Attendance, Punctuality and Absences: Students must attend all assigned clinical hours. Absences require prior notification to the clinical instructor and the clinical site where possible. Excessive tardiness or unexcused absences will be grounds for remediation or removal from the clinical placement.

4. Health and Safety: Students must observe infection control policies, wear required personal protective equipment, and follow employer and facility procedures for exposure incidents. The student must immediately report occupational exposures or work-related injuries to the preceptor and the educational clinical coordinator and follow incident reporting procedures.

5. Substance Use and Fitness for Duty: Being under the influence of alcohol, illicit drugs, or impairing prescription medication while on clinical duty is prohibited. The institution reserves the right to require testing where reasonable suspicion exists. Positive tests or refusal to test may result in removal from clinical placements and disciplinary proceedings.

6. Documentation and Records: Clinical documentation must be accurate, timely, and truthful. Falsification, alteration, or misrepresentation of records is grounds for disciplinary action, up to and including dismissal from the program.

7. Mandatory Reporting: Students must report suspected abuse, neglect, or other conditions subject to mandatory reporting in accordance with applicable law and facility policy. The student acknowledges understanding of mandatory reporting obligations and will cooperate with investigations.

8. Removal, Suspension, and Appeals: The educational institution or clinical site may remove a student from a clinical placement for cause, including but not limited to safety risks, policy violations, or inability to meet clinical objectives. The student will be provided notice of removal and information on the applicable academic appeals or grievance process as set forth in program policies.

9. Compliance with Site Policies: Students must follow all policies of the clinical site while assigned, including security, electronic device use, dress code, and patient visitation policies. Noncompliance with site policy may be addressed by the site and the educational program.

10. Liability and Insurance: Students are responsible for maintaining any required personal professional liability insurance and personal health insurance where required by the program or clinical site. The institution's provision of placement does not constitute an assumption of liability for individual student acts or omissions.

Acknowledgment and Consent

By checking the box below and signing this form, I acknowledge that I have read, understand, and will comply with the Educational Clinical Rules contained herein. I attest that all information and documentation I have submitted to support clearance is true and accurate to the best of my knowledge. I understand that violation of these rules may result in removal from clinical placement and academic or disciplinary action.

I acknowledge and agree to comply with the Educational Clinical Rules.

If the student is under the age of 18 at the time of signing, a parent or legal guardian must sign this form on the student's behalf.

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