BSN Clinical Requirements Packet
**ONLY for students accepted into the nursing program**
NAME: ____________________________ DATE: _________________
Students will not be allowed to start first semester clinical practicum without completing all clinical requirements. Copies of all of the requirements listed below MUST be placed in a 9x12 envelope, in the order listed, with this checklist attached to the outside. All of the clinical requirements and forms will be discussed in detail at the BSN orientation on December 9, 2008. Students must print all of the forms below to bring to orientation. Do NOT turn in the clinical packets before orientation. Submit this packet to the administrative coordinator, Sarah Blackburn, in Metro 310 on February 2, 2009. The packet must be complete when submitted; if any requirements are omitted or out of sequence, the packet will be returned, and the student will not be admitted into clinical rotations until a complete packet is submitted.
_____ 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**:
_____ Malpractice Insurance (38.00)
_____ JACHO and HIPPA testing fee (5.00)
_____ Clinical ID Badge (8.50)
_____ School of Nursing patches ($3.00) -- required for the lab coat and tunic top only.
_____ 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. A Medication list of current prescription and nonprescription (including herbal medicines) for drug screening must be turned into UTC Student Health Center along with the Medical and Physical Health form.
_____ Copy of health insurance card
_____ Copy of CPR card -- must be Healthcare Provider
_____ Completed JCAHO & HIPPA requirements through the TCPS system.
_____ Completed influenza vaccine form
_____ Signed confidentiality statement
_____ Signed information release form
_____ Signed dismissal policy
_____ Signed background check policy
_____ Signed drug screening agreement form (complete drug screening policy available here)*
_____ Signed N95 Fit Test agreement form*
*Students must complete their Drug Screening and N95 Fit Test at Workforce Corporate Health at Erlanger Hospital. Students must have a permission letter from the School of Nursing when going to Workforce Corporate Health.
**To assist students in planning their expenses while they are in the nursing program, the School of Nursing has prepared an estimate expenses report for students.
***Clinical Requirements Procedure
Questions? Email April Anderson or phone at 423-425-4670 or Email Sarah Blackburn or phone at 423-425-4750.
