MSN FNP Clinical Requirement Packet
NAME: ____________________________ DATE: _________________
Students will not be allowed to start their clinical practicum without completing all clinical requirements. Copies of all of the requirements listed on this checklist MUST be placed in the student's clinical file in the Administrative Assistant's office. All of the clinical requirements and forms will be discussed in detail during FNP fall class meeting. Clinical packets are to be turned in on the first day of class in the fall semester and updated on the first day of class every semester following (see Clinical Requirement Policy in the Graduate Student Handbook). If everything is not placed into the student's clinical requirement file, the student will not be admitted into clinical rotations until everything is complete.
_____ Photograph-Must be a clear headshot, approximately passport photo size, with only you in the photo.
Receipt(s) from the Bursar’s Office for the following fees (must submit a copy of the receipt for file):
_____ Malpractice Insurance (38.00)
_____ JACHO and HIPPA testing fee (5.00) -- if you have completed this through your employer within the last 6 months, you may provide documentation from your employer.
_____ Clinical ID Badge (8.50)
_____ UTC Student Health Center form completed in full and signed by Center staff -- UTC Student Health requires you to complete and bring them the Medical and Physical Health form before they can complete the Student Health Center form. You cannot be seen by the UTC Student Health Center unless you bring both the Student Health Center and Medical and Physical Health forms.
_____ Copy of health insurance card
_____ Copy of CPR card --
Students must maintain current certification throughout the program. The CPR course must be one that includes infant and child, and defibrillation. The School of Nursing offers the course at the beginning of each semester (signs are posted throughout the building).
_____ Medication List -- please place in sealed envelope with your name on the front.
_____ Completed influenza vaccine form -- in the spring only
_____ Completed H1N1 vaccine form
_____ Signed confidentiality statement
_____ Signed information release form
_____ Signed background check policy
_____ Signed drug screening agreement form (complete drug screening policy available here)
_____ Signed N95 Fit Test agreement form
_____Completed JCAHO & HIPPA requirements through the TCPS system. -- not required if you have completed this through your employer within the last 6 months, you may provide documentation from your employer.
____ Completed N95 Fit Test (must be done yearly)
____ Completed drug screen
Students who have not completed the Drug Screening and N95 Fit Test through their employer, must complete them at Workforce Corporate Health at Erlanger Hospital. Students must obtain a permission letter from the School of Nursing before going to complete their testing at Workforce Corporate Health. If students have completed the drug screening and N95 Fit Test through their current work position, they must submit documentation from their supervisor.
Drug testing is done prior to starting the FNP program and only for cause thereafter. The N95 Fit testing is an annual requirement.
Questions? Email April Anderson or phone at 423-425-4670 or Email Lori Purple or phone at 423-425-4644.
