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Step by Step Guide to the Clinical Placement ProcessAfter receiving verification that your application for a clinical placement has been accepted by a healthcare facility, you need to complete the following requirements before your clinical begins.
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Step 1: FVHCA Health Requirements and Background Checks must be completed
- Health Requirements
- Medical Influenza Exemption Note: Form to apply for exemption of the influenza vaccination requirement.
- Hepatitis B Documentation Form (Required)
- Background Check Information
Step 2: Complete Orientation Requirements
- Complete Modules below, which are accessed by clicking on the files below:
| Module 1: Infection Prevention, Bloodborne Pathogens & Safety: Student Orientation |
| module_2_hippa_compliance_and_professionalism.pdf |
Complete Facility Specific Orientation for the organization providing your clinical placement:
(If you are utilizing an organization not listed below, jump to Step #3.)
(If you are utilizing an organization not listed below, jump to Step #3.)
- Ministry Health Care / Affinity
- Agnesian Healthcare
- Aurora Health Care/Fond du Lac Market area
- ThedaCare
- Evergreen Retirement Community
Step 3: 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 |
Final Reminders
- Wear your student badge and dress accordingly.
- While working in the health care facilities please adhere to dress codes and always wear a badge that identifies you.
- Some facilities may assign a badge to you. Please return it at the end of your clinical, or you may be charged a replacement fee and/or your school records held.
- Remember to keep patients at the center of your experience and practice safely.
- Ask questions if you are not familiar with something.
- Seek out experiences as they come available and have a great learning experience!
