Paperwork Requirements

Requirements for clinical experience courses

Dear Medical Assisting Student:

Please read this letter carefully and be sure you understand what you must get done before you can begin your clinical experience hours.

1. Health Records Checklist: All required health records, immunizations, TB skin tests, Flu Shot, CPR certification, etc. must be completed and uploaded to Castle Branch prior to the start of the clinical experience. A list of all required health requirements will be provided to the student by the college.
2. Liability Insurance:  You are required to purchase liability insurance from the college for approximately $11.00 per semester.  You can go to your Self-Service aunt on People Soft, do an Account Inquiry and print off an itemized statement for the current semester showing it has been charged to your account.  Submit that statement with these forms. This must be completed prior to beginning clinical experience.
3. Clinical Requirements:  All Clinical students must have certain health tests and immunizations.  You must also take a drug screen test and have a criminal background check performed.  These requirements are outlined in this letter.
4. Urine Drug Screen:  You must also have a current urine drug screen as defined by the college completed (a routine urinalysis does not include a drug screen.). The drug screen is to be completed using an approved lab and the results will be loaded directly into Castle Branch and reviewed. If you are taking any prescription medications that may interfere with the drug screen test, you must provide this information to the testing lab prior to completing the Urine Drug Screen.
5. “Statement of Understanding”:  Please complete the statement and return with all other forms.
6. Background Check:  Henderson Community College now requires a current background checks for all students enrolling in Nursing (RN & LPN), Medical Assisting and Medical Laboratory Technician Programs.  This process is designed to meet the requirements for a student’s assignment to clinical practice in affiliating healthcare agencies. Henderson Community College has worked with Castle Branch to establish an acceptable screening procedure.  Students who fail to submit a background check will not be eligible for clinical placement.  No other form of background checks can be accepted.

Important notes

1. If you have a positive drug screen, you must verify that you are taking a medication which causes the positive test. This must be in writing from your doctor.
2. If you have a felony conviction on your background check most clinical sites will not accept you for clinical experience.
3. The College uses Castle Branch to store all health, background screening, and drug screening, CPR, and Liability Insurance documentation. The college will provide information on creating and accessing your Castle Branch Account. Students are responsible for uploading all required documentation to Castle Branch.

Statement of Understanding

Student Name:

Program:

College:

As a student of this program, I agree to the rules, regulations, policies and procedures as stated below.

1. The program requires a period of assigned, guided clinical experiences either in the college or other appropriate facility in the community.
2. For educational purposes and practice on “live” models, I consent in allowing other students to practice non-invasive procedures on me as I will practice these same procedures on them under the guidance and direct supervision of my instructor.  The nature and educational objectives of these procedures have been fully explained to me.  No guarantee or assurance has been given by anyone as to any problem that might be incurred as a result of these procedures.
3. I have read and agree to comply with the Drug and Alcohol Policy of both the college and the facility.
4. These clinical experiences are assigned by the instructor for their educational value and thus no payment (wages) will be earned or expected.
5. It is understood I will be a student within the clinical facilities that affiliate with my college and will conduct myself accordingly.  All required and published personnel policies, standards, philosophy, and procedures of these agencies will be followed: I also agree to obtain all health screenings and immunizations required by the affiliating agency.
6. I have read and agree to adhere to the college’s policies, rules, and regulations related to the program for which I am applying.
7. I understand the information regarding a patient or former patient is confidential and is to be used only for clinical purposes within an educational setting.
8. I understand the educational experiences and knowledge gained during the program do not entitle me to a job; however, if all educational objectives and licensure requirements are successfully attained, I will be qualified for a job in this occupation.
9. I understand any action on my part inconsistent with the above understandings may result in suspension of training.
10. It is understood that I am liable for my own medical and hospitalization expenses.
11. I understand that I will be accountable for my own actions; therefore, I will carry adequate limited professional liability insurance during the clinical phase of the program.
12. I have read, understand each statement, and agree to abide by the above.

To be signed by legal guardian if applicant is a minor.

Student Signature:

Date:

As the legal guardian of the student named above, I agree to the above conditions.