Stanly Community College

Phlebotomy Course

Student Handbook

Stanly Community College 141 College Drive Albemarle, NC 28001

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Phlebotomy Course Mission Statement

The Phlebotomy Course at Stanly Community College (SCC) is a certificate course that prepares individuals with the skills and knowledge needed to obtain blood specimens for the purpose of laboratory analysis. The SCC Phlebotomy course will provide a quality and diverse education while maintaining high standards of instruction and delivery. Instruction will be accomplished in a professional environment that includes lecture, lab, and clinical experiences.

Phlebotomy Course Objectives:

1. Prepare students to have entry level knowledge of phlebotomy and healthcare. 2. Prepare students to serve as quality employees for the healthcare community. 3. Prepare students to successfully pass national certification exams.

General Information

The SCC Phlebotomy course is a 192 hour certificate course (72 hours classroom and 120 clinical hours)

Admission Requirements

In order to be considered for admissions to the Stanly Community College Phlebotomy course, applicants must: 1. Submit proof of US High School Diploma or GED completion or an evaluated non-US High School Diploma and Reading Assessment at 10th grade reading level. 2. Direct patient care experience or training.

After being accepted into the Phlebotomy course students will be required to submit: 1. Copy of Driver’s License 2. Medical Form demonstrating current immunizations and PPD 3. Criminal background Check 4. Drug Screen

Criteria to receive a Certificate

Students must meet all class and clinical requirements in order to obtain a certificate for the phlebotomy course.

Phlebotomy Certification Examinations

Students who complete the Phlebotomy Program at Stanly Community College are encouraged to take a national certification examination for phlebotomy technicians. Certification represents the recognition of someone who has met all of the required qualifications specified by the certifying agency or association.

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Grading Policy

Student will receive an “S” (Satisfactory) if they adhere to the attendance requirements, and they obtain a quiz/test/homework combined score of 75 or above. In addition, Students must also satisfactorily complete a final check off at the end of the course to receive a “Satisfactory” grade. Students will receive a “U” indicating achievement is Unsatisfactory if they do not adhere to the attendance requirements or if their quiz/test/homework average is 74 or less.

Class Attendance

Class attendance is an integral part of the learning process, and each student is expected to attend all classes for which he or she is registered. Absences do not relieve the student’s responsibility of meeting the requirements of the class. Students may be withdrawn by the instructor if class requirements are not being met.

Students must attend at least 60 of the 72 hours of classroom meeting in order to receive a certificate. In other words, missing more than 12 hours of the classroom portion of the course will result in an “Unsatisfactory” grade. Any assignment missed must be made up on the student’s own time.

A tardy will be recorded when students are 30 minutes or more late. This includes tardiness at the beginning of class and when returning from breaks. Two tardies will be recorded as 1 class absence (remember students are only allowed 2 class absences). Any absence beyond this will result in a course grade of Unsatisfactory and dismissal from the course.

Any time missed by a student due to leaving the classroom prior to class end will also be recorded and deducted from the student’s attendance record.

Although there is no written dress code for classroom attendance, students are expected to exhibit a neat, tasteful appearance.

Classroom Policies

1. No cell phones are allowed in class. Students must attend to all outgoing and incoming calls, texts, emails, etc. during breaks. 2. No food is allowed in the classroom. 3. The instructor reserves the right to dismiss any student from the classroom for the day due to behavior that is disruptive to learning. This may include but is not limited to: a. Cell phone usage b. Disruptive conversation c. Combative behavior d. Dangerous behaviors during lab

** Time missed due to dismissal will be deducted from the student’s attendance record **

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Clinical Attendance

A student must not miss more than 2 scheduled clinical days without a statement from a physician. All clinical time that is missed due to absences must be made up. It is the responsibility of the student to arrange all make up time with his/her preceptor to ensure that all 120 hours are completed. Students must complete 120 hours of clinical and the required number of sticks in order to receive a certificate of completion. Students must keep up with their clinical hours on the Phlebotomy Time Sheet.

Clinical Policies

The SCC Phlebotomy course provides classroom and laboratory learning opportunities to develop competencies required of a phlebotomist prior to being placed in a clinical rotation. After being placed in a clinical setting, clinical faculty will participate in evaluations of the student.

Each student is required to complete a total of 100 venipunctures and 25 skin punctures and observe (if available) 5 arterial punctures. Students must also complete 120 hours of clinical study with an approved preceptor.

General Conduct  Respect all patients’ privacy and confidentiality.  Do not discuss patients where others may hear your conversation.  Report away from the patients’ bedside.  Obscene or profane language will not be tolerated in the clinical area.  Do not use inappropriate or offensive commentary or body language toward others.

No personal calls or personal visits are allowed in the clinical setting, except in emergency situations.

The ability of students to meet clinical objectives, demonstrate phlebotomist competencies, and maintain patient/client safety is required to receive a passing grade. If a student is unable to meet these criteria, they may be dismissed from the course and will receive a grade of Unsatisfactory for the course. All students will be responsible for keeping their time recorded on the time sheet provided. Once the student arrives to the clinical site, they must put the time they arrived and have it signed by their Preceptor. At the end of the clinical day , the student must put the time they leave clinical and have it signed by their Preceptor.

Students will treat clinical assignments with respect: reporting to the facility on time, in professional dress and attitude. Preceptors have the right to dismiss a student from clinical.

Clinical Competencies

Each student will be required to complete a total of 100 venipunctures and 25 skin punctures and observe (if available) 5 arterial punctures. Each successful competency must be documented on the Phlebotomy Progress Sheet form and signed by the preceptor witnessing the procedure.

Clinical Dress Code and Appearance

Professional appearance and appropriate attire are important attributes for anyone in the medical profession. Students will be required to purchase white uniforms for clinical rotations (see attached uniform policy).

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Identification Badges

Students must be clearly identified as such in every clinical setting to distinguish them from clinical site employees and other health profession students.

Photo identification badges will be made and issued by SCC for students to wear in all clinical settings. These may be obtained at Eagle’s One Stop on the Albemarle campus. You must present your Student ID number and $2 to obtain an ID badge.

Clinical Schedule

A clinical schedule will be compiled on or before the last week of classroom work. However, once the schedule is made, the student must adhere to it. The instructor and coordinator make every effort to accommodate the preferred clinical location of the student, but it is up to the student to adjust his/her schedule around his/her clinical assignment. If a student is rejected by his/her assigned clinical site due to criminal background check and/or drug screen results, the student will not be assigned an alternative clinical and will therefore receive a grade of Unsatisfactory for the course.

Criminal Background Check and Drug Screen

Clinical affiliates may require all students that participate in clinical activities and patient care at their facility have a criminal background check and drug screening prior to clinical rotations. This mandate is a recommendation from the Joint Commission on Accreditation of Healthcare Organizations. To fulfill contractual agreements with clinical affiliates, Phlebotomy Students are required to submit an official criminal record check and drug screening prior to participating in clinical rotations.

Each clinical affiliate has the right to deny any student access for clinical rotations based upon criminal background or drug screen results. This denial would result in the student’s inability to complete the Phlebotomy course and subsequently, the student would receive an “Unsatisfactory” grade for the course.

Students are under a continuing obligation to report any allegations or charges of a misdemeanor(s) or felony(s) that occur after the criminal background check has been originally submitted. Failure to provide updated or corrected information in a timely manner may be cause for removal from a clinical facility and from the phlebotomy course.

Criminal record checks and drug screening shall be at the student’s expense. Failure for the student to comply with this policy will result in the student not being allowed to progress in this program.

Student Resources

The phlebotomy classroom and lab is EB 104. A good deal of equipment is housed in this room that will be utilized with the multiple courses that SCC offers. If you are unfamiliar with the equipment and have not covered it in class, please do not experiment with it. It is up to the students and faculty to ensure the classroom and equipment is maintained in proper order. If you are aware of any equipment that is not in proper working order, please report it immediately to the faculty. Equipment or chemicals should not be removed from the classroom without permission of the instructor.

Students will have a central area on the SCC webpage called Student Resources to get to services that students use every day. From this portal page, students will be just a click away from the email account, the library, grades, online classes, and more. The Student Resources page will be an easy, convenient way to navigate to various college information and announcements. Students will find links to the following:

1. Student Email Accounts: All students have an SCC email account. 5

2. WebAdvisor: WebAdvisor is a very important resource available to students. Students are able to view grades, request a transcript of their grades, etc. Students may also register for the courses online through WebAdvisor. 3. College-wide Online Help Desk: This feature is a one-stop center where your questions can be directed quickly and efficiently. Ask questions about financial aid, registration, technical support for online classes and more. Your questions will be answered by Help Desk personnel or directed to an appropriate area of the college.

The Library at SCC, located in the Snyder building, has various materials related to phlebotomy and other health care areas. In addition, Internet access is available in the library and in the Student Success Center located in the Webb Center.

Liability Insurance

All students are required to purchase liability (malpractice) insurance for protection in the event of a liability claim of a personal or profession nature resulting from the performance of clinical duties. This fee will be collected with the course fee. Students will not be allowed to participate in clinical activities until this fee is paid in full.

Clinical Facility Orientations

Clinical affiliates may require orientation sessions or modules. Each student will be responsible for completing orientations as necessary. The student will be held accountable for policies and procedures discussed for each clinical facility.

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Stanly Community College C O N F I D E N T I A L Student Exposure Incident Report

Student’s Name: Date of Incident: Date Reported: Reported to: Position:

Type of Exposure Incident:  Needle stick/sharps accident  Contact with mucous membrane (eyes, mouth, nose)  Contact with skin (circle all that apply): Broken Chapped Abraded Dermatitis Prolonged contact Extensive contact Exposure To:  Blood  Body Fluid  Vaginal Secretions  Seminal Fluid How did exposure incident occur?

List protective devices used at time of exposure:

Description of student’s activities as related to exposure:

Describe immediate interventions: Was the area: Washed? Flushed? Did the injury bleed freely?  Yes  No Was antiseptic applied:  Yes  No Other: Dates of student Hepatitis B vaccinations:

Source of exposure (exact location exposure took place):

Source of exposure: Known, HbsAG status?  Yes  No If yes, HbsAG+: HbsAG - : Unknown, high, or low risk potential for HBV?  Yes  No

Signature of Person Preparing Report Date

Student’s Signature Date

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Viral Hepatitis B Info Sheet What is Hep B? Hepatitis B is caused by a virus that attacks the liver. The virus, which is called hepatitis B virus (HBV), can cause lifelong infection, cirrhosis (scarring) of the liver, liver cancer, liver failure, and death.

How is HBV spread? It is spread when blood from an infected person enters the body of a person who is not infected. For example, HBV is spread through having unprotected sex with an infected person, sharing drugs, needles, toothbrushes, razors, or through needle sticks or sharps exposures on the job, or from an infected mother to her baby during birth.

What are the symptoms? Sometimes a person with HBV infection has no symptoms at all. The older you are the more apt you are to have symptoms. You might be infected with HBV and not know it but still be contagious. The symptoms are: Yellow skin or yellowing of the whites of your eyes Tiredness (Fatigue) Loss of appetite Nausea Abdominal discomfort Dark urine Clay-colored bowel movement Joint pain

Who should get vaccinated? All babies at birth All children 0-18 years of age who have not been vaccinated People of any age whose behavior or job puts them at risk for HBV infection

Are the HepB vaccines safe? Yes. They have been shown to be safe when administered to both adults and children. Over 4 million adults have been vaccinated in the US, and at least that many children have received hepB vaccine worldwide.

What are the risk factors for HepB?  Having unprotected sex with an infected person  Having unprotected sex with more than one partner  Using IV drugs/sharing needles  A male having unprotected sex with another male  Living in the same house with someone who has chronic HBV infection  Having a job that involves contact with human blood and body fluids  Having hemophilia

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Inclement Weather During periods of inclement weather, Stanly Community College will close when conditions are hazardous. When the College is closed due to adverse weather, all extracurricular activities will be canceled. If the College is closed or operating on a delayed schedule due to inclement weather, students can hear a recorded announcement by calling 704-982-0121 (Alb) or 704-888-8848 (CFC). Students may monitor the college’s website www.stanly.edu The website’s main page banner will announce closings and/or delayed schedules. Students may also monitor the media outlets listed below to determine if the college is closed or operating on a delayed schedule. No announcement means that the college is operating on a normal schedule.

RADIO WZKY 1580 AM WSPC 101 AM WJRM 1390 AM WBT 1110 AM WLNK 107.9 FM WIXE 1190 AM WLYT 102.9 FM WKKT 96.9 FM WRFX 99.7 FM WMMG 96.1 FM WEND 106.5 FM WPEG 97.9 FM WBAV 101.9 FM WSAT 1280 AM WSTP 1490 AM

TELEVISION WBTV- Channel 3 NEWS 14 CAROLINA- Channel 14 WCCB- Channel 18 WCNC- Channel 36 7 Cable 6 WFMY- Channel 2 WGH PIEDMONT- FOX 8 Greensboro WSOC –Channel 9

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STANLY COMMUNITY COLLEGE BLOODBORNE PATHOGEN EXPOSURE PROTOCOL PHLEBOTOMY

What to do if I receive exposure to blood or body fluids during class exercises or clinical rotations?

Please follow the step-by-step procedure outline below if you receive exposure to blood or body fluids while you are completing the Phlebotomy Program requirements: 1) Inform your supervisor immediately  At a clinical site: this is your preceptor or whoever is supervising your performance of venipuncture sand skin punctures the day of the incident  In the classroom: this is your instructor

2) If you are at a clinical site: follow the guidelines of the medical office or hospital where the incident occurred. This may include filling out that agency’s incident report. Your preceptor should advise you of the medical treatment you need to seek. You may opt to receive this treatment at the clinical site, from your own doctor, or from an emergency care clinic. Be sure to keep copies of all charges incurred.

3) Fill out the “Record of Student Injuries and Illnesses Occurring at Stanly Community College” form, giving complete and accurate information for item numbers 1 through 17.

4) Submit the completed “Record of Student Injuries and Illnesses Occurring at Stanly Community College” form and any bill for treatment of the exposure to:

Dana Craven, RN, MSN Eddins Bldg. RM 111-C Stanly Community College 141 College Drive Albemarle, NC 28001 704-991-0342 [email protected]

NOTE: Be sure that you take any bloodborne pathogen exposure seriously. You should complete all of the recommended follow-up treatment without exception. Please contact Dana Craven at (704) 991-0342 or [email protected] if you have any questions or concerns.

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Stanly Community College

Phlebotomy Program

Criminal Background Check and Urine Drug Screen

All SCC phlebotomy students who will attend clinicals as part of their program curriculum will be required to complete and pass a state-wide criminal background check and a urine drug screen. Your instructor will provide you with the necessary forms and appropriate deadlines on the first day of class. The drug screen will be conducted on the campus where you are attending class and, to the best of our ability, will be conducted during class hours. Any student unable to make the scheduled screening time, will be required to drive to the office of Jeskri Associates to complete their test within 24 hours after the scheduled testing date. Any student failing to follow this instruction will be dropped from the program. If you have attended a previous class that required you to have a CBC done and it has been 6 months or less, you will not be required to pay for a second CBC for this class. The instructor will have a form for you to complete that will allow Mr. Allen to pull your previous results. Any questions regarding the CBC and/or UDS may be directed to Dana at 704-991-0342.

Cost:

Criminal Background Check: $40 money order if you have lived in NC for the past 7 years;

$50 money order if you have lived outside NC at any point in the

past 7 years.

$10 money order if you have had a CBC completed within the past 6 months at

SCC.

***This payment MUST be in a money order format. Personal checks and cash will not be accepted.

Money orders should be made out to Allen’s Professional Investigations. ***

Urine Drug Screen: $35 cash, check or separate money order. Must present a photo ID at the time of the screening.

***The CBC and UDS are conducted by two different companies so separate payments are required**

Addresses of Jeskri Associates

Monroe Office Wadesboro Office 1821 Rocky River Road North 217 Leak Avenue Monroe, NC 28110 Wadesboro, NC 28170 (704) 291-9991 (704) 695-9171 Office Hours: 8am-4:30pm Office Hours: 9am-4pm

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Cell Phone Usage

It has been brought to my attention that an updated cell phone policy is needed for all NA classes. At the time the original rules were created, texting was not an option. Now not only is it an option but an annoyance to many of the instructors. Because of this, here are the new cell phone rules that become effective today and will be included in all upcoming NA Class Handbooks.

1. All cell phones will be silenced (not put on vibrate) during class time and will be stored off the student’s desk out of view.

2. Making or receiving phone calls, texting, and/or checking the phone will not be conducted during class times in the classroom.

3. All phone usage will be conducted during break times and outside of the classroom only.

4. Cell phones will NOT be brought into the clinical site. All cell phone usage at the clinical site will occur during break times.

5. In case of a family emergency during class time, the instructor will be made aware of the situation by the student at the beginning of the class. At the discretion of the instructor, the student may be permitted to leave the phone on vibrate and respond to the call when it comes by taking the phone call outside of the classroom.

6. In case of a family emergency during clinical time, the preceptor will be made aware of the situation by the student at the beginning of the clinical day. The student will be required to give out the facility phone number as their contact number for that day and will be permitted to take the phone call when it comes in. No cell phones in the clinical site.

7. Any student caught texting in the classroom and/or during class time will be disciplined appropriately.

8. Students caught talking, texting or in possession of a cell phone during clinical hours will be disciplined appropriately.

9. This statement of rules represents a Verbal Warning. First offense after the reading of these rules will receive a Written Reprimand and the student will be required to place the cell phone on the instructor’s desk during any and all class time to be retrieved only during breaks and at the end of the class day. Second offense will receive an automatic dismissal from the program.

As healthcare workers dealing with the well being of our patients, residents and clients, we cannot allow for mistakes to be made over and over. Rules, guidelines and polices are in place for the safety and security of all involved. Disregard for these rules, policies and guidelines will be handled swiftly. 12

Phlebotomy Code of Conduct

Stanly Community College reserves the right to maintain a safe and orderly educational environment for students and staff. A student’s conduct that disrupts or threatens to disrupt the college community will be met with appropriate disciplinary action as listed below. The purpose of this Code of Conduct is not to restrict the student’s rights but to protect the rights of the individual in their academic pursuits.

The following set forth rules of conduct prohibit certain types of student behavior.

1. Academic Dishonesty: taking or acquiring possession of any academic material from a college employee or fellow student without permission; receiving or giving help during tests; submitting papers or reports as originals that are not the student’s own; plagiarism.

2. Theft of, misuse of or damage to college property, or theft or damage to property of the member of the college facility or unauthorized entry into a college facility or unauthorized presence in a college facility after closing hours.

3. Violation of the Drug and Alcohol Policy which in part reads: Stanly Community College prohibits the unlawful use, possession, distribution, manufacture or dispensation of any controlled substance or alcohol while on campus or facilities leased by the college, or at college supported functions. (Policy may be found in the LRC and in the Faculty/Staff Handbook).

4. Lewd, indecent or offensive conduct or clothing including public physical or verbal action of distribution of obscene or libelous written materials. To include clothing that displays cleavage or a bare midriff.

5. Mental, physical or verbal abuse of any person (employee or student) on campus or at campus sponsored functions.

6. Possession or use of a firearm, incendiary device or explosive except in connection with a college approved activity. This is inclusive of any unauthorized use of any instrument designed to inflict serious bodily injury to any person. Restrictions on the possession of a firearm do not apply to on duty law enforcement personnel.

7. Forgery, alteration or misuse of college documents, records or instruments of identification with intent to deceive.

8. Violation of a local, state or federal criminal law on college premises.

9. Bodily harm to a resident, patient or client of a clinical site will result in immediate dismissal from SCC if the allegation is substantiated.

10. All cell phones will be silenced not placed on vibrate during class time. Making or receiving phone calls and texting will be reserved for break times or at the end of class. Students caught texting during class will be disciplined appropriately. In the case of an emergency, the student will excuse themselves from the classroom and place/take their call away from the door to the classroom. Upon return to the classroom, the phone will be silenced.

11. Cell phones will NOT be brought into the clinical site. A student found talking, texting or in possession of a cell phone during clinical hours, will be disciplined appropriately.

12. Sleeping during class/clinical hours is prohibited. Students caught sleeping during class/clinical time will be sent home and the hours subtracted from their total hours missed. 13

Stanly Community College Phlebotomy Uniform Code

Professionalism and appearance are important qualities of the Nurse Aide Student. As a student of Stanly Community College, you will represent the college while at the clinical site and will be held to a higher standard than the employees of the facility in which you are a guest. As a Nurse Aide, you need to place the residents at ease by your appearance of cleanliness, neatness and professionalism.

Dress Code is as follows: 1. The uniform is to be solid white. A white uniform dress is acceptable. Uniform should fit in a manner which does not expose the lower back during bending. Uniform should be neat and clean.

2. Solid white socks should be worn with white shoes. Sneakers are acceptable. Shoes must be closed toed and non-cloth.

3. White T-shirts, white tank tops, or white undershirts should be worn underneath a white top for modesty.

4. A lab jacket is optional and can be of any color or style.

5. The Stanly Community College name badge will be worn at all times above the waist and with the face and/or name exposed.

6. Hair will be neat and clean. Longer hair will be pulled back off the face and long ponytails will be secured to the head.

7. Nails will be short and clean. NO artificial nails will be permitted. If nail polish is worn, it must be pastel and solid. No blacks, red, or any dark shade.

8. Very little make up and perfume/cologne should be worn due to it causing irritation to the resident’s respiratory tract.

9. Jewelry should be minimal. Wedding band is permitted but it is recommended that the diamonds and other raised rings be omitted for resident safety. Earrings should be stud earrings. No hoops or dangling earrings are permitted for safety. No necklaces or chains around the neck for the student’s safety. No pins or decorative ornaments should be applied to the uniform for infection control reasons. The student is required to wear a watch with a sweeping second hand for obtaining vital signs. Arriving to clinical without a watch is considered out of dress code.

10. No body piercing should be visible. Clear appliances may be placed in the pierced opening for clinicals. The clinical site has the authority to ask the student to remove even the clear appliance and the student must conform or go home.

11. No tattoos should be visible. Clothing will be worn in a manner in which to cover any existing tattoos. If unable to cover the tattoo with clothing, a Band-Aid or bandage of appropriate size or an ace wrap may be applied over the tattoo to include any tattoo on the neck, back or hand.

12. Any infraction of the SCC Phlebotomy Dress Code will warrant being sent home and the hours subtracted from total hours missed. If the total hours missed is greater than 11 hours, the student will be dropped from the course.

13. No cell phone usage while inside the clinical site. No texting while in the clinical site. Students caught with cell phones during clinical hours will be disciplined appropriately at the instructor’s discretion.

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STANLY COMMUNITY COLLEGE PHLEBOTOMY

STUDENT CONTRACT

1. I have been given a copy of the Phlebotomy Course Description/Outline and handbook and the instructor has reviewed it with me. 2. I understand that in order to pass this course I must be able to meet course objectives and follow all procedures and protocols listed. 3. I will not engage in disruptive behavior in either the classroom or clinical area, and I understand that such behavior will be grounds for dismissal from the course. 4. I understand that I will be a guest in the clinical facility to which I am assigned and will follow their policies and procedures for patient care and conduct. I also understand that should the clinical facility decide my behavior is unacceptable, I will not be eligible to complete the phlebotomy course. 5. I understand that in order to get my certificate, I must pass both the 72 hour lecture/lab portion and the 120 hour clinical portion of the class, which will include 100 venipunctures and 25 capillary sticks. 6. I understand that I am entitled to feedback from my instructor regarding my progress. 7. I understand that dishonest actions such as lying, cheating, forgery, or theft will be grounds for dismissal from this course. 8. I understand that if my instructor believes I am not acting in a professional manner while practicing phlebotomy skills, that I may be immediately dismissed from class. 9. I understand that if I am found to be incompetent in my clinical skills or if I fail the final written exam, I will be dismissed from the course. 10. I understand that if I break confidentiality rules, I could be dismissed from the course.

Student’s Signature______Date______

Instructor’s Signature______Date ______

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Stanly Community College Phlebotomy Program

The Use of Human Subjects Policy

Per Stanly Community College’s Use of Human Subjects Policy, students must be made aware of the possibility that throughout this course of study, it may become necessary to utilize their person for the purpose of skill demonstration and/or skill practice.

In order to be considered for course completion all students are required to perform and participate in all assigned tasks in a proficient manner both in the lab setting and in the clinical setting.

Phlebotomy Students may be the human subject for:  fellow classmates as they practice obtaining vital signs;  instruction in proper selection of venipuncture sites, proper infection control, proper site preparation, and proper tourniquet application and removal by the instructor;  the practice of proper venipuncture blood specimen collection techniques on various veins in the arms, wrists and hands using various types of collection equipment in preparation for preceptor supervised clinical work;  the practice of proper capillary puncture blood specimen collection (finger sticks) in preparation for preceptor supervised clinical work; and for  fellow classmates as they obtain the national-certification mandated 25 capillary finger sticks prior to the clinical rotation.

No Phlebotomy student will be permitted to apply any modality or procedure or use another student as a human subject for any reason without the prior written consent of that student and the prior documented statement of student qualification by the instructor.

Student’s Statement: I have been made aware of the possibility of being used as a human subject throughout the Phlebotomy Program in which I am enrolled. This may include being stuck in the veins of my hands, wrists, or arms with needles by my instructor and/or classmates on more than one occasion; and the performance of repeated capillary punctures on my fingers. I have had an opportunity to have my questions answered and agree to participate in venipuncture and finger stick blood draws as needed and within reason.

Name______Date______

SCC/2014

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STANLY COMMUNITY COLLEGE PHLEBOTOMY PROGRAM RECEIPT OF HANDBOOK

Printed Name ______

I have received, read, and understand the following policies and have had a chance to have all my questions answered:

 Phlebotomy Handbook with Attendance Policy  Phlebotomy Code of Conduct  Phlebotomy Dress Code  Hepatitis B Information  Biohazard Lab Policy (if applicable)

Student Signature______

Instructor Signature______

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STANLY COMMUNITY COLLEGE PHLEBOTOMY PROGRAM STUDENT INFORMATION RELEASE

I,______, hereby release any and all information regarding my training and performance as a Nurse Aide Student to prospective employers (i.e. Director of Nursing, Human Resource Personnel). In addition, I agree to release my complete student record in regard to Nurse Aide Training to accrediting agencies for college and for licensing boards approving SCC program standards.

Student Signature______

Date______

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STANLY COMMUNITY COLLEGE PHLEBOTOMY PROGRAM CONFIDENTIALITY AGREEMENT

I, ______, agree that information containing names, diagnosis, treatment or personal behavior given in the classroom, clinical site, in the online class, or in business areas will not be discussed with anyone other than my immediate supervisor. I agree that this is a serious breach of the Health Insurance Portability and Accountability Act (HIPAA) and could result in my removal from this course.

Student Signature______

Date______

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STANLY COMMUNITY COLLEGE PHLEBOTOMY PROGRAM HEPATITIS B RELEASE FORM

This is to verify that I have received information regarding the risks and benefits of the Hepatitis B vaccine (HBV) to healthcare workers and have had an opportunity to have my questions answered.

I understand that all approved clinicals sites used by Stanly Community College require the phlebotomy student to receive, or provide proof of having previously received, at least the first shot in a series of three for the HB vaccine.

I hereby release Stanly Community College from any responsibility as a result of consequences that may occur due to receiving the vaccine.

Student Signature______

Date______

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