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Getting StartedBefore being able to do a clinical rotation at a FVHCA facility, there must be a current legal affiliation agreement between your school and the facility you wish to be considered for placement. Please ask your school coordinator/program director to contact the facility regarding the legal affiliation agreement. Healthcare facility contacts can be found here.
Next, your school must submit a Graduate Request form to the healthcare facility on your behalf. If you have someone in mind who could potentially serve as your preceptor, your school coordinator/program director should list their name on the form. Your school coordinator/program director will let you know if the healthcare facility is able to accept you for placement. Once approved, continue with the orientation steps listed below so that your school can then complete the Graduate Required Student/Faculty Information form and submit it to the healthcare facility. Instructions on how to fill out the form can be found here. |
Orientation
Once you have been accepted at a facility and your placement has been confirmed, you must complete the following requirements BEFORE your clinical start date.
Step 1: FVHCA Health Requirements and Background Checks must be completed
- Health Requirements Requirements
- Medical Influenza Exemption Note: Form to apply for exemption of the influenza vaccination requirement.
- Hepatitis B Documentation Form (Required)2.19uniform_background_check_requirements.pdf
- Background Check Information
Step 2: Complete Orientation Requirements (Modules 1 & 2)
- Complete Modules 1 and 2, which are accessed by clicking on the files below:
| Module 1: Infection Prevention, Bloodborne Pathogens & Safety Orientation |
| Module 2: HIPAA, Compliance & Professionalism Orientation |
Step 3: Complete Facility Specific Orientation for the organization providing your clinical placement
(If you are utilizing an organization not listed below, jump to Step #4.)
(If you are utilizing an organization not listed below, jump to Step #4.)
- Ministry Health Care / Affinity
- Agnesian Healthcare
- Aurora Health Care/Fond du Lac Market area
- ThedaCare
- Evergreen Retirement Community
Step 4: Complete and Submit Forms to your Instructor/School Coordinator (Forms A, B &C)
You will need to print off and sign three forms (Forms A, B, & C) in order to complete all requirements. Your signature indicates acceptance of responsibility and accountability for the information presented. Turn in all forms to your Instructor or school coordinator. (For electronic signature please use Internet Explorer. Does NOT work in Chrome)
You will need to print off and sign three forms (Forms A, B, & C) in order to complete all requirements. Your signature indicates acceptance of responsibility and accountability for the information presented. Turn in all forms to your Instructor or school coordinator. (For electronic signature please use Internet Explorer. Does NOT work in Chrome)
| form-a-confidentialityagreement_11.17.pdf |
| form_b_module_completion_form_11-17.pdf |
A Healthcare Facility Specific Orientation (Form C) must also be completed.
** If you are attending clinical placement at an organization not listed in Step #2, you still need to complete all forms (A, B, & C) and turn them into your school coordinator/instructor.** (Note: Most often, Form C is completed on the first day of orientation at your clinical placement site).
If you have any questions about these requirements or forms, see your school coordinator/instructor.
** If you are attending clinical placement at an organization not listed in Step #2, you still need to complete all forms (A, B, & C) and turn them into your school coordinator/instructor.** (Note: Most often, Form C is completed on the first day of orientation at your clinical placement site).
If you have any questions about these requirements or forms, see your school coordinator/instructor.
| Form C: Healthcare Facility Specific Organization - Confirmation of Completion Form |