Clinical Agency Affiliation List

198 Pages·2017·1.59 MB·English

UNIVERSITY OF SOUTH ALABAMA
COLLEGE OF NURSING
September 14, 2018
Clinical Agency Affiliations and Locations

Agency Name Programs Agency Requirements
Covered
1st Operations Medical Group MSN, DNP, Post Student must complete Attachment 1
Graduate Certificate,
Hurlburt Field, Florida
MSN to DNP
2D Medical Group MSN Student must complete the Trainee Agreement
Addendum
Barksdale AFB, Louisiana
3HC Home Health & Hospice Care Undergraduate and
Graduate Students
Goldsboro, North Carolina
4th Medical Group
Seymour Johnson AFB, North
Carolina
5th Medical Group-Minot AFB MSN and DNP Student must complete Trainee Addendum.
Student may utilize agreement for a period of no
Minot AFB, North Dakota
more than 2 years at a time.
18th Medical Group, Kadena Air Nurse Practitioner Student must complete the Trainee Agreement
Addendum
Base
Japan
21st Medical Group, Peterson Air Executive Nursing Executive Nursing Admin DNP ONLY
Force Base Admin DNP ONLY
Student must complete Attachment 1
Colorado
35th Medical Group, Misawa AFB Advanced Practice Student must complete Trainee Agreement
Addendum
Japan
48th Medical Group, Executive Nsg Please contact the following for interest in this site.
RAF Admin DNP ONY
ALANE C. GARLISI, Lt Col, USAF, NC
Lakenhealth , UK Education and Training Flight Commander
48th Medical Group, RAF Lakenheath, UK
[email protected]

Student must complete the Trainee Agreement.
99th Medical Group, Mike Advanced Practice Student must complete Trainee Agreement
Addendum
O’Callaghan Federal Hospital
Nellis Air Force Base, Nevada
Renewal in process-set to expire
on 9/9/2018

354th Medical Group, Eielson, Nurse Practitioner Student: Must complete the Trainee Agreement
Addendum, provided by the facility.
AFB, AK
Alaska (Pediatrics Department
Only)
377th Medical Group, Kirtland AFB Student must complete and sign the Trainee
Agreement Addendum. While utilizing this
New Mexico
agreement, students are prohibited from engaging
in off-duty employment at USAF MTF.
436th Medical Group Women’s Health Student must complete the Trainee Agreement
Nurse Practitioner Addendum
Dover Air Force Base
ONLY
Dover, Delaware
509th Medical Group RN-BSN, MSN, Student must complete Trainee Agreement
Whiteman AFB, Missouri DNP Addendum
673rd Medical Group, Join Base, RN-BSN, MSN, Attachment 1 and 2 for Trainee Agreement
Elmendorf-Richardson DNP Addendum
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UNIVERSITY OF SOUTH ALABAMA
COLLEGE OF NURSING
September 14, 2018
Clinical Agency Affiliations and Locations

Agency Name Programs Agency Requirements
Covered
JBER, Alaska

A
Agency Name Programs Agency Requirements
Covered
Abrom Kaplan Memorial Hospital Undergraduate and
Graduate Nursing
Kaplan, Louisiana
Students
Access Community Health Network Graduate Nursing USA/Faculty: Please see Exhibit A for all Facility
Programs Sites.
Chicago, IL (see Exhibit A for complete
Student: Must obtain comprehensive health
lists of affiliates covered by agreement) insurance. Shall provide to Agency evidence that
they have met all requirements of CPR certification,
hepatitis B vaccination, and OSHA compliance for
prevention of transmission of blood borne pathogens
and TB before being placed in the Program. A
criminal background check and drug screen, as
specified in Exhibit B, and as required by and
acceptable to Agency, are required of each
Participant prior to being placed in the Program.

Each student prior to his/her arrival at the Agency
Site are required to:

(i) Follow the administrative policies, standards, and
practices of Agency; and

(ii) Obtain medical care at his/her own expense for
any injuries or illnesses sustained as a direct or
indirect result of his/her participation in the Program;
and

(iii) Provide his/her own transportation and living
arrangements; and

(iv) Report to the assigned Agency Site on time and
follow all established regulations of Agency during
the regularly scheduled operating hours of the
Agency Site; and

(v) Conform to the standards and practices
established by USA while participating in the
Program; and

(vi) Meet the personal, ethical and professional
standards required of employees of Agency and
conduct themselves at all times consistent with the
applicable professional Code of Ethics and the
applicable standards of the Joint Commission and/or
other relevant accrediting or regulatory bodies; and

(vii) Obtain prior written approval of Agency and
AFFILIATE before publishing any material relating to
the Program.
Access Health Care Physicians, Nursing USA/Faculty: See Exhibit A-Teacher/Learner
Expectations.
LLC
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UNIVERSITY OF SOUTH ALABAMA
COLLEGE OF NURSING
September 14, 2018
Clinical Agency Affiliations and Locations

Agency Name Programs Agency Requirements
Covered
Spring Hill, Florida
Students must maintain health insurance and
provide proof of health insurance to USA. Agency
may request copy of proof.
Adams Compassionate Healthcare- Undergraduate and
ACHN Graduate Nursing
Students
Chantilly, Virginia
Adena Health System MSN, DNP Agency contact: Monica Climer, Coordinator
Graduate Clinical [email protected] 740-
Chillicothe, Ohio
779-8821
USA/Faculty: Complete Attestation (Exhibit A).
Inform facility of curriculum and sequence and of all
courses and clinical experiences for each student.
Notify facility of proposed schedule of student
assignments to facility, including dates, number and
names of students, their level of academic
preparation.

Student: Complete Exhibit B. Obtain health
insurance coverage for the period of the clinical
experience.

Florida Hospital (Adventist Health Nursing Agreement covers NURSING
Undergraduate Student must be N-95 respirator fit tested prior to
System/Sunbelt, Inc.) (to include: •
NON APRN attending clinical. Testing can be done for $25 at the
Florida Hospital Altamonte - Agency clinic. Nursing Students please see Exhibit C
601 E. Altamonte Drive, Altamonte –Criminal Background Disqualifications Guidelines.
Exhibit D- Physical and Mental Requirements. USA
Springs, FL
must provide a letter of good standing indicating that
• Florida Hospital Apopka – a background check and drug screen has been
conducted. Provide in writing the names of students.
201 N. Park Avenue, Apopka, FL

• Florida Hospital Celebration Agency Contacts:
– 400 Celebration Place,
Non Clinical Rotation- Debbie Stunkard-
Celebration, FL
[email protected]
• Florida Hospital East
Orlando – 7727 Lake Underhill Clinical [email protected]
(graduate students please go to www.FHGME.com
Road, Orlando, FL
for application.
• Florida Hospital Kissimmee –
Student’s research projects with additional
2450 N. Orange Blossom Trail,
requirements: Each student will need to obtain
Kissimmee, FL approval from the Principal Investigator on the
• Florida Hospital Orlando & research study. The research must be approved in
advance by and subject to the review of Hospital's
Childrens – 601 E. Rollins Street,
Institutional Review Board or receive a determination
Orlando, FL of non-human subjects research. If research involves
• Florida Hospital Winter the use of animals, the research must be subject to
the oversight by an Institutional Animal Care and
Garden – 2000 Fowler Grove, Blvd,
Use Committee. Student may not serve as Principal
Winter Garden, FL Investigators, but may assist as staff personnel,
provided they have appropriate supervision.
• Winter Park Memorial
Students must obtain written approval of both parties
Hospital – 200 N. Lakemont before publishing any articles, and will submit all
Avenue, Winter Park, FL completed articles, etc., to Hospital for review and
approval no less than 60 days prior to the date of
Maitland, Florida
submission for publication, disclosure or
presentation.
Florida Hospital (Adventist Health APRN Agreement covers NURSING
Student must be N-95 respirator fit tested prior to
System/Sunbelt, Inc.) (to include: •
attending clinical. Testing can be done for $25 at the
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UNIVERSITY OF SOUTH ALABAMA
COLLEGE OF NURSING
September 14, 2018
Clinical Agency Affiliations and Locations

Agency Name Programs Agency Requirements
Covered
Florida Hospital Altamonte - Agency clinic. Nursing Students please see Exhibit C
–Criminal Background Disqualifications Guidelines.
601 E. Altamonte Drive, Altamonte
Exhibit D- Physical and Mental Requirements. USA
Springs, FL must provide a letter of good standing indicating that
• Florida Hospital Apopka – a background check and drug screen has been
conducted. Provide in writing the names of students.
201 N. Park Avenue, Apopka, FL

• Florida Hospital Celebration Agency Contacts:

– 400 Celebration Place,
Non Clinical Rotation- Debbie Stunkard-
Celebration, FL [email protected]
• Florida Hospital East
Clinical [email protected]
Orlando – 7727 Lake Underhill
(graduate students please go to www.FHGME.com
Road, Orlando, FL for application.
• Florida Hospital Kissimmee –
Student’s research projects with additional
2450 N. Orange Blossom Trail,
requirements: Each student will need to obtain
Kissimmee, FL approval from the Principal Investigator on the
research study. The research must be approved in
• Florida Hospital Orlando &
advance by and subject to the review of Hospital's
Childrens – 601 E. Rollins Street, Institutional Review Board or receive a determination
Orlando, FL of non-human subjects research. If research involves
the use of animals, the research must be subject to
• Florida Hospital Winter
the oversight by an Institutional Animal Care and
Garden – 2000 Fowler Grove, Blvd, Use Committee. Student may not serve as Principal
Winter Garden, FL Investigators, but may assist as staff personnel,
provided they have appropriate supervision.
• Winter Park Memorial
Students must obtain written approval of both parties
Hospital – 200 N. Lakemont before publishing any articles, and will submit all
completed articles, etc., to Hospital for review and
Avenue, Winter Park, FL
approval no less than 60 days prior to the date of
Maitland, Florida submission for publication, disclosure or
presentation.
Adventist Florida Hospital Ocala BSN, MSN, DNP USA/Faculty: Must provide student name, residence
address, phone number to agency at least ten days
(previously Munroe Regional
prior to placement at facility. Prior to commencing
Medical Center) performance per the agreement, the COLLEGE shall
Ocala, Florida ensure health status of student and faculty entering
premises is compliant with the following
requirements of the AGENCY and shall produce
documentation upon request:
Statement by a healthcare provider that student is
medically capable of performing internship related
duties and is free of any communicable diseases.
Documentation of a negative ppd within the last year
(two – step ppd if more than one year) or Chest X-
Ray if past positive ppd. Documentation of active or
passive immunity to Measles, Mumps, Rubella,
Rubeola, Diphtheria, Pertussis, Tetanus, Hepatitis B
and Varicella.

Student must contact Workforce Development
Coordinator with Munroe to complete orientation
packet prior to beginning clinicals.
Adventist Health System Georgia, RN-BSN, MSN, DNP Students may be required to undergo a health
examination.
Inc. d/b/a Gordon Hospital
Adventist Medical Center Nursing USA/Faculty: Complete a verification form provided
by Agency setting forth the name and information for
Hanford, California
each Student.
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UNIVERSITY OF SOUTH ALABAMA
COLLEGE OF NURSING
September 14, 2018
Clinical Agency Affiliations and Locations

Agency Name Programs Agency Requirements
Covered
Student: Complete Exhibit A. Student must provide
copy of background check to Agency, at their own
expense.
Affiliated Physicians Group MSN and DNP USA/Faculty: At least 15 working days prior to
clinicals provide written evidence of requirements set
Needham, Massachusetts
forth in Appendix A and provide a course description
including objectives, a description of the evaluation
system. Submit Appendix B for each clinical rotation.
Student must be appropriate under the guidelines
promulgated by the Massachusetts Executive Office
of Health and Human Services (EOHHS).
See below for Background check Requirements:
Background Checks. The School shall check the Criminal
Offender Record Information (“CORI”) for each
Participant who may be present on APG’s premises as part
of the Program. The School shall disqualify Participants
as appropriate under the guidelines promulgated by the
Massachusetts Executive Office of Health and Human
Service (“EOHHS”) and the Department of Mental Health
(“DMH”). These guidelines may be found in the EOHHS
Human Resource Policy Manual. No Participant will be
permitted to participate in the Program without a
satisfactory CORI check. The School shall also notify
each Participant that a CORI check will be performed and
that the Participant’s participation in the Program is
contingent on the outcome of the CORI check. The
School shall comply with all requirements relating to
dissemination of information related to the CORI check.
CORI checks and disqualification decisions must be made
at least 10 business days prior to the date on which the
Participant is scheduled to begin. The School may comply
with these CORI obligations independently, or it may
request that APG conduct CORI checks and disqualify
Participants as appropriate on the School’s behalf, at a
cost to the School. If the School opts to perform the
CORI checks and make determinations regarding
disqualification independently, the School will represent
and warrant that it has performed a CORI check for each
Participant and disqualified ineligible Participants
consistent with EOHHS and DMH guidelines, and will
provide documentation of these facts upon request. If the
School delegates its CORI obligations to APG, APG will
initiate checks only after it has received a release from the
School for each Participant and all decisions by APG shall
be final.

Affinity Health Group, LLC Undergraduate and
Graduate Students
Monroe, Louisiana
AHS Hillcrest Healthcare System, MSN, DNP See Exhibit A for covered facilities. See Exhibit C for
Background Requirements.
LLC (Includes the following sites:
Student must complete and sign Exhibit D.
Bailey Medical Center, Hillcrest
Hospital Claremore, Hillcrest
Hospital Cushing, Hillcrest Hospital
Henryetta, Hillcrest Medical Center,
Oklahoma Physicians Group- Utica
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UNIVERSITY OF SOUTH ALABAMA
COLLEGE OF NURSING
September 14, 2018
Clinical Agency Affiliations and Locations

Agency Name Programs Agency Requirements
Covered
Park Clinic), Hillcrest Hospital
South)
Tulsa, Oklahoma
Aiken Regional Medical Centers Nursing USA/Faculty: Prior to the beginning of experience
provide number of students, possible dates of
Aiken, South Carolina
experience, names of students, objectives of
program.

Students: Must sign a confidentiality agreement
provided by the Facility. Provide evidence to the
Facility of having received any immunizations and
testing that may be required by Facility. Must obtain
and maintain health insurance while in a clinical
experience at Facility.
Akron General Medical Center Graduate GRADUATE STUDENTS.
USA must notify agency one month prior to
Akron, Ohio
beginning of clinicals for each student. USA Faculty
must provide orientation session to preceptor to
include: goals, objectives of program, faculty’s
contact information, and overview of expectations.
Students must have current RN license in the state
of practice. Student must participate in orientation
procedures as required by agency.
Alabama Board of Nursing Graduate Nursing USA/Faculty: Shall ensure that its faculty and
Programs Students do not participate in any clinical learning
Montgomery, Alabama
experience which may pose a conflict of interest. A
conflict of interest exists if the Student or faculty
member is working on or will have access to data
regarding a matter that pertains to him/herself or an
employer, family member, educational institution, or
friend of the Student or faculty member, as well as
any other relationship or factual scenario which could
reasonably be construed to compromise the integrity
of the ABN’s regulation of nurses and nursing
education programs. Provide the ABN with a
schedule and learning objectives for the student prior
to the beginning of the clinical learning experience.
USA understands and agrees that its Students and
faculty shall not be permitted to access any data of
the ABN prior to executing a Confidentiality
Agreement and, if necessary, a Data Use Agreement
or other agreements required by the ABN. The
Educational Institution agrees that any Student or
faculty member who violates a Confidentiality
Agreement, Data Use Agreement, or other
agreement required by the ABN will be removed
from the ABN clinical site and may face other
consequences as described in said Agreements.
Alabama Department of Public Nursing Contact: Angela Dubose-
[email protected].
Health, (Alabama inclusive)
Alabama Regional Medical Services Undergraduate and
Birmingham, Alabama Graduate Nursing
Students
Alabama Providence Healthcare Undergraduate and Covers Providence Hospital and Clinics. See
Services (providence hospital medical group) Graduate Nursing Directory for complete listing.
Mobile, Alabama

Alameda Health System Undergraduate and USA/Faculty: Submit all clinical rotation requests
Graduate Nursing through the Centralized Clinical Placement System.
Oakland, California
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UNIVERSITY OF SOUTH ALABAMA
COLLEGE OF NURSING
September 14, 2018
Clinical Agency Affiliations and Locations

Agency Name Programs Agency Requirements
Covered
See Exhibit F for the Primary Source Verification.
These must be met at least 14 days prior to clinical
experience. Must make an appointment with the site
at least 14 days prior to clinical experience-see
Exhibit F. Student must complete orientation at
facility.
Alaska Tribal Health Nursing Agency Education Contact: Zachary Owen
[email protected].
Consortium/Alaska Native Medical
USA/Faculty: Provide to Facility a listing of students
Center who will be participating in clinicals. Also provide to
Anchorage, Alaska Facility any change in student’s status. Provide
opportunity to receive Hepatitis B vaccine to clinical
Renewal in process-set to expire
students.
on 9/30/2018 Student: Must provide drug test results to Facility's
Human Resources Department during the on-

boarding process. Must maintain personal medical
insurance coverage while at Facility. Must have
training in universal precautions and transmission of
blood-borne pathogens.

Alegent Health NP
Omaha, Nebraska
Allegan Healthcare Group MSN and DNP
Allegan, Michigan
Allegheny Health Network MSN and DNP See Exhibit A-Required Health Screening Clearance.
Submit to Agency prior to clinical experience,
Pittsburgh, Pennsylvania
number of students, dates and hours that they will be
assigned to Agency. The expected level experience
that they will be assigned, expected objectives and
health requirements listed on Exhibit A.
Alliance Health Center Nursing Programs USA/Faculty: Provide the names and information
relevant to training within a reasonable time prior to
Meridian, Mississippi
clinicals. Agency contact is: Leigh Ann Posey-
[email protected]
Student: Must obtain criminal background check and
child abuse clearance check prior to clinicals. Must
sign a patient confidentiality agreement, which
Agency will provide.
AllianceHealth Durant (previously RN-BSN, MSN, DNP USA/Faculty: See Addendum 1 & 2 for Patient Care
Medical Center of Southeastern Oklahoma) Duties
Student: Completed addenda 4 & 5. Must have
Durant, OK
health insurance during their clinical rotation at
Facility.
AllianceHealth Woodward Nurse Practitioner Student: Complete Addenda 4, 5 and 6. For each
Instructor and Student who will participate in the
Woodward, Oklahoma
clinical rotations the School shall provide to the
Facility verification of the following immunizations
and tests:

1. A complete Hepatitis B vaccination series
(series of three or waiver)
2. Negative PPD or chest X-ray
3. MMR vaccinations(s) or positive titers
4. A written verification of varicella history,
varicella vaccinations or a varicella titer by a
physician or a physician’s designee
5. A background check that includes OIG.

The School shall require that each Student and
Instructor before beginning the clinical rotation have
current CPR certification that meets standards
acceptable to the Facility.
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UNIVERSITY OF SOUTH ALABAMA
COLLEGE OF NURSING
September 14, 2018
Clinical Agency Affiliations and Locations

Agency Name Programs Agency Requirements
Covered
Alpine Medical Associates Undergraduate and
Graduate Nursing
Jersey City, New Jersey
Students
AltaPointe Health Systems, Inc. (sites BSN, RN-BSN, MSN, Please note the contact person for clinicals are as
DNP follows:
covered: Bayview Professional Assoc.,

Altapointe Children’s Outpatient, AltaPointe
AltaPointe Health Systems, Inc. (Baldwin County
Adult Outpatient, EastPointe Hospital,
Mental Health site)
BayPointe Hospital, Zeigler Outpatient ARS, Renee Presley- [email protected] or (251)
Community Counseling Center of South 378-6528 or [phone]
Mobile County, Community Counseling
Center of Washington County, Community AltaPointe Health Systems, Inc. (Mobile site)
Counseling Center of Fairhope, AHS Kelly Hughes - [email protected] or (251) 473-
4423
Community Counseling Center of Foley,
Community Counseling Center of Bay
Minette)
Mobile, Alabama

American Family Care, Inc. BSN, RN-BSN, MSN,
DNP
Birmingham, Alabama
American Health Network of Ohio, USA/Faculty: Verify annual negative Tuberculin skin
test or if positive, a negative chest X-ray; Hepatitis B
PC
immunization status; and physical exam prior to
Indianapolis, Indiana clinicals.
Amory HMA Physicians Graduate Nursing USA/Faculty: See Addenda 1&2 Student Duties.
Management, LLC (covers; Amory Nurse Practitioner
Student: Must complete Addenda 4-6. Must contact
Pediatric Clinic, Primary Medicine Brenda Langford in HR to set up a time to attend
Clinic, Family Medicine Clinic) orientation. Her number is 662-256-6286.
a negative TB skin test within the past year or, in the
Amory, Mississippi
event of a positive TB skin test, a chest x-ray within
the past three (3) years; OR provide evidence of no
TB disease per negative result of interferon-gamma
As of 5/3/2017 now owned by Curae
release assay blood test (T-Spot or Quantiferon
Health, Inc. Gold) within twelve (12) months of student activity at
facility; (b) a completed series of Hepatitis-B vaccine,
having begun the series, or informed refusal of the
vaccine; and (c) any other appropriate immunizations
requested by Facility.

Ensure that Students are aware of the Substance
Policy. See Addendum 4.

Provide the Facility with a copy of each Student’s
completed (1) Substance Policy Consent Form (See
Addendum 4) and (2) Background Consent Form
(See Addendum 5).

Criminal Records Check
Students’ criminal records shall be checked at the
federal, state, and local levels before referring
Students to Facility and thereafter as often as is
required by law. The Facility CEO will have the
authority to make the final decision regarding the
referral of any Student with a criminal record.
Students must execute a Student Background
Consent Form (See Addendum 5).
Andalusia Regional Hospital
Andalusia, Alabama
8
UNIVERSITY OF SOUTH ALABAMA
COLLEGE OF NURSING
September 14, 2018
Clinical Agency Affiliations and Locations

Agency Name Programs Agency Requirements
Covered
Anderson Regional Medical Center BSN, RN-BSN, MSN,
DNP
and Anderson Regional Medical
Center-South Campus South
Campus covers the Children’s
Clinic, Airpark Family Medical Clinic,
Anderson Cardiac Surgical Assoc,
Anderson Ear, Nose, and Throat,
Anderson East MS Endoscopic, The
Purvis Clinic, Anderson Urology
Clinic of Meridian, Anderson
Neurology Center, Anderson Family
Medical Center-Enterprise
Meridian, Mississippi
Angel Medical Center, Inc. (Mission Following programs Questions for onboarding and orientation processes:
only; Mission Education Services
facility)
MSN FNP 828-213-0779
Franklin, North Carolina MSN Dual Role [email protected]
MSN Adult Geron
CNS USA/Faculty: Submit roster of students who will
participate in the clinical experience at Facility.
Students-May be required to participate in any
required orientation process developed by the
Facility.
AnMed Health
Anderson, South Carolina
Anniston Pediatrics, Inc. Undergraduate and
Graduate Students
Anniston, Alabama

Apogee Medical Management, Advanced Practice Students: Must maintain health insurance during
Nursing clinicals. Must have education in OSHA/Blood Borne
Inc.(covers all of the US)
Pathogens and HIPAA regulations prior to clinicals.
Phoenix, Arizona
Appalachian Regional Healthcare USA/Faculty: Will send information to
Boone, North Carolina the facility prior to initiation of clinicals to
include dates of assignment, number of

students, name and pertinent information
about students, objectives for clinical,
curriculum outline and types of previous
healthcare/clinical experience. Provide facility
with an exposure control plan and guidelines
for its students in accordance with OSHA
Standards for Bloodborne Pathogens and TB
or other applicable guidelines upon request.
Student: Must obtain adequate health
insurance.

Appalachian Regional Healthcare, USA/Faculty: Must complete Exhibit A, return to
contract office for signature, then return to Education
Inc.
Coordinator at ARH facility. Contact the Education
Hazard, Kentucky Coordinator at the ARH facility student will be
seeking placement.

Student: Obtain health insurance coverage.

9
UNIVERSITY OF SOUTH ALABAMA
COLLEGE OF NURSING
September 14, 2018
Clinical Agency Affiliations and Locations

Agency Name Programs Agency Requirements
Covered
Archbold Memorial Hospital (also Undergraduate and Students must have annual PPD.
Graduate Nursing
covered: Brooks County Hospital,
Grady General Hospital, Mitchell
County Hospital, Mitchell
Convalescent Center, Glenn Mor
Nursing Home, Archbold Health
Services and Archbold Medical
Group)
Thomasville, Georgia
Arizona Community Physicians, LLC Undergraduate and Students must complete Appendix A.
Graduate Nursing
Tucson, Arizona
Arkansas Children’s Hospital Nursing Faculty must provide facility official with students’
names, dates, and hours of assignment and level of
Little Rock, Arkansas
care by students.

Contact:
Tracey L. Stone
Academic Nursing Education
[email protected]

Arkansas Department of Health & Women’s Health, USA/Faculty:
Adult, Community Agrees to provide the Regional Patient Care
Human Services (Arkansas
Health Nursing, BSN, Manager a list of the following for all students and
inclusive) MSN, APRN, DNP. faculty who will be on-site at the Department of
Health:
A list of names of the students and faculty;
Proof of tuberculosis testing or screening
Proof of MMR, Hepatitis B, Tetanus, Varicella, and
Influenza vaccinations

Any student or faculty who will be on site at the
Department of Health who is not up to date on the
vaccinations listed must receive the required
vaccinations prior to reporting to their assigned
site(s).

Any students or faculty who does not wish to be
vaccinated must provide the Patient Care Manager
with proof of vaccination exemption prior to reporting
to their assigned site(s). The Department of Health
Immunization Medical Director reserves the right to
accept or deny any exemptions for the purpose of
student /faculty participation in Department of Health
on-site clinical activities.
Any Student or faculty whose exemption is accepted,
are subject to the Department of Health’s policies
related to direct patient care, and may be required to
wear a mask or be excluded from participating in
certain activities during an outbreak situation, up to
and including exclusion from the Department of
Health premises.
Evidence of a license in good standing in nursing,
medical, pharmacy, or allied health for each faculty
member, if that faculty member will be on-site during
the clinical rotation.
.
Provide the Department of Health site a list of
learning objectives for the student and timeframe in
which objectives are to be completed.
10