Instructions (Please Read Before Continuing)

Completion of Fresno California Student Orientation Attestation Clinical Education, Practice & Informatics

Instructions (Please Read before continuing): 1.Complete item #2, #3, #4 and #5, whichever is applicable. (You do not need to complete all) 2.For each student who is requesting a clinical rotation, you must print out items 6-15 (one sided, no staples); read, sign, date and return all documents to the Clinical Education department no later than 4 weeks prior to your clinical start date at the Fresno Medical Center. 3.Failure to return documents on time may lead to a delay or cancellation of your clinical experience 4.Read applicable items 16 – 21. (These are read only material, you don’t need to print) 5.Handwrite your initials for each applicable item. 6.Read the statement at the bottom of this document; sign and date and return.

Initia Item ls Orientation Documents

2 Individual Student Rotation Processing Form

3 Student Group Rotation Processing Form

4 HealthConnect Security Form

5 Faculty Processing Form . n 6 Student Orientation Attestation (This document) r u t e r

7 Confidentiality Agreement d 8 n Elder and Dependent Abuse Form a

e 9 Child Abuse Form t a d

Universal Precautions for Blood-borne Pathogens , n g review i

10 ( ) s

11 Hand Hygiene (review) d a e r

12 Flu Declination , t n i 13 Hepatitis B Declination r P 14 KPHC Non-Disclosure and Attestation Student Safety Quiz (signed after reviewing pp(#18) & handbook 15 (#21) below) l a i

16 HIPAA 101 - Quick Reference (all) r e t

17 Principles of Responsibility (all) a M

y 18 Nursing Orientation (Nursing) l n O 19 High Alert Medication (Faculty) d a

20 Student Healthcare P&P (Faculty) e R 21 2017 Student Handbook (all)

The applicable contents above are designed to provide you with information so that you can meet the expectations and compliance regulations of Kaiser Permanente Fresno.

D:\Docs\2017-12-28\062f63d3232556c887ee6432ce1bcf63.doc This educational content is designed to provide students the opportunity to gain knowledge, apply information/skill(s) to the student experience and partner with Kaiser Permanente in achieving organizational goals of providing exceptional quality service to the members we service.

Your signature below indicates that you understand Kaiser Permanenente’s expectation and limitations as it relates to the student role. The content will be immediately applied in the performance of your student functions.

I (student) have reviewed and acknowledge my understanding of the student orientation content provided to me by Kaiser Permanente’s Clinical Education Department.

I (instructor) have validated the student identified below has completed the student orientation process at Kaiser Permanente.

By signing below you are stating that . . .  you have received, read, and understand the applicable contents thereof.  the information assists in creating a safe work environment and practice.  you understand it is the expectation of Kaiser Permanente that you apply this information in the performance of your responsibilities as a student.

______Instructor Name/Signature Date

______Student Name (Please Print)

______Student Signature Date

______KP Education Designee Signature

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