Educational Hospital Handbook

EDUCATIONAL HOSPITAL HANDBOOK

Student Information

Student Name:     Student ID:

Date of Birth:     Program / Grade:

Parent / Guardian (If Student is Minor)

Student is under 18 years of age:

Program Enrollment & Clinical Assignment

Program Start Date:     Expected Completion Date:

Clinical Rotations will be assigned by the educational hospital program. Students must comply with clinical site requirements, orientations, and schedules. Failure to meet clinical requirements may result in removal from clinical placement or dismissal from the program.

Health, Immunizations, and Infection Control

Immunization and testing requirements are mandatory for participation in clinical activities. The educational hospital requires proof of current immunizations and screening as indicated below. Students authorize release of immunization records and test results to the program for verification.

Tuberculosis screening (TB test or IGRA): Current    MMR (Measles, Mumps, Rubella): Verified    Varicella (chickenpox): Verified

Hepatitis B series: Completed    Annual Influenza vaccine (when required by site): Received    Other required vaccines:

By initialing the following, the student acknowledges the requirements and agrees to comply with infection prevention policies of the educational hospital.

Bloodborne pathogen training completed:    Infection control orientation completed:

Confidentiality, Privacy, and Patient Rights

Students will have access to patient information in connection with clinical learning. Students must maintain confidentiality of all patient information in accordance with applicable patient privacy laws and program policies. Unauthorized access, disclosure, or use of patient information is grounds for immediate disciplinary action, up to and including dismissal and reporting to licensing or credentialing entities.

I acknowledge that I have read and understand the confidentiality and privacy obligations and will complete any required privacy training prior to participating in clinical assignments.

Acknowledgment of Confidentiality:

Background Checks, Drug Screening & Mandatory Training

As a condition of enrollment and clinical placement, students must consent to criminal background checks and may be required to submit to drug screening. A positive background check or drug screen, or failure to provide required documentation, may prevent placement and may result in dismissal. The program reserves the right to require additional training modules as conditions of clinical participation.

Consent to background check and drug screening:

Attendance, Professional Conduct & Discipline

Students must comply with attendance policies, professional standards, and clinical site rules. Professional misconduct, falsification of records, breach of confidentiality, unsafe clinical practice, or failure to meet academic or clinical standards may result in disciplinary action up to suspension or dismissal. Students are responsible for reporting incidents, exposures, and safety concerns promptly to the designated supervisor.

I have read the attendance and conduct policies and agree to abide by them:

Incident Reporting & Emergency Contact

In an emergency, I authorize the educational hospital and its agents to seek and authorize emergency medical care on my behalf if I am unable to do so. I agree to be responsible for the costs of any medical or hospital services rendered.

Authorization for emergency treatment:

Academic Standards, Assessment & Grievance

Academic performance is assessed according to program-specific grading rubrics. Students subject to academic or clinical performance concerns will be provided written notice and an opportunity to respond. Grievance procedures exist for disputes; resolution may include remedial work, probation, or dismissal depending on severity and prior record.

I acknowledge that I have received, read, and understand the Academic Standards and Grievance procedures contained within this handbook:

Privacy & Release of Records

By signing this Handbook Acknowledgment, the student authorizes release of immunization records, background check results, and training completion records to clinical sites and program partners as required for placement and patient safety. Such disclosures will be limited to the information necessary for verification and compliance.

Consent to release records:

Certification and Agreement

I certify that the information I have provided on this form is true, complete, and correct to the best of my knowledge. I understand that falsification, omission, or misrepresentation may result in denial of clinical placement, dismissal from the program, or other disciplinary actions. I agree to comply with all policies, procedures, and lawful directions issued by the educational hospital and clinical sites.

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