Educational Health Science Addendum

EDUCATIONAL HEALTH SCIENCE ADDENDUM

Effective Date:

PARTIES AND PROGRAM

Student Name:

EMERGENCY AND HEALTH CONTACTS

IMMUNIZATIONS, TESTING, AND CERTIFICATIONS

The following immunizations and health clearances are required for participation in clinical experiences. Attach supporting documentation as required by the program. The student affirms possession of the following (check each that applies and provide dates where requested).

MMR (Measles, Mumps, Rubella) — Date:

Varicella (chickenpox) — Date/Proof:

Tdap (Tetanus, Diphtheria, Pertussis) — Date:

Hepatitis B series or documented immunity — Date/Result:

Influenza (seasonal) — Season/Date:

COVID-19 vaccination / booster — Date(s):

Tuberculosis screening (PPD/IGRA) — Last test date: Result:

Current CPR/BLS certification (required where indicated) — Expiration date:

Physical examination completed within 12 months:

SCREENING, BACKGROUND CHECKS, AND DRUG TESTING

Clinical partners and the program may require criminal background checks, national database searches, and drug and alcohol screening as a condition of participation in clinical placements. The student acknowledges and consents to such screenings where required and understands that noncompliance or an adverse result may result in denial of clinical placement or removal from the program.

I acknowledge that I may be required to undergo background checks and drug testing as a condition of participation.

Costs associated with required screenings, vaccinations, or testing are the responsibility of the student unless otherwise stated in writing by the institution.

CONFIDENTIALITY, TRAINING, AND COMPLIANCE

Students engaged in clinical activities must complete required training, including but not limited to infection control, bloodborne pathogens, and privacy/confidentiality standards. Students must maintain confidentiality of patient information in accordance with applicable law and institutional policy. Breach of confidentiality or failure to complete mandatory training may result in disciplinary action, including removal from clinical placement.

ASSUMPTION OF RISK, RELEASE, AND INDEMNIFICATION

The student acknowledges that participation in health science educational activities and clinical placements involves inherent risks, including exposure to infectious agents and other hazards. To the fullest extent permitted by law, the student agrees to assume all risks associated with participation and releases the institution, its clinical partners, officers, employees, and agents from liability for personal injury or property damage arising out of or related to such participation, except to the extent caused by the institution's gross negligence or willful misconduct. The student further agrees to indemnify and hold harmless the institution for claims by third parties arising from the student's acts or omissions.

Emergency Medical Treatment: I authorize the program and clinical partners to obtain emergency medical treatment on my behalf if necessary, and I understand that I am financially responsible for any such care.

ACCOMMODATIONS

If the student requires academic or clinical accommodations due to a disability or medical condition, the student must provide written documentation to the institution's designated office. Requests for accommodations will be evaluated in accordance with applicable policy and law.

CERTIFICATION AND ACKNOWLEDGMENTS

By signing below, the student certifies that the information provided on this addendum is complete and accurate to the best of their knowledge. The student agrees to comply with all health, safety, and training requirements of the program and understands that failure to meet these requirements may result in denial of clinical placement, academic consequences, or dismissal from the program.

I certify that the information provided is true and accurate.

I have read, understand, and agree to the terms of this Educational Health Science Addendum.

ADDITIONAL INFORMATION

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