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 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 during FNP fall class meeting. Do NOT turn in the clinical packets before this fall class meeting. Submit this packet to the administrative coordinator, Sarah Blackburn, in Metro 310 no later than January 7, 2009 for the December 2010 Class of FNP students. 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) -- 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. 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 --
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).
_____ Completed influenza 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.
*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. Students utilizing Workforce Corporate Health must have a permission letter.
Questions? Email April Anderson or phone at 423-425-4670 or Email Sarah Blackburn or phone at 423-425-4750.
