Speakers
Gerianne Babbo ~
Professor, Associate Dean of
Nursing
Bethany Mauden ~ Office
Support Supervisor
(Presenter)
Chere Perrone ~ Clinical
Nursing Programs Administrative
Office
Office Hours (subject to change)
Monday: 7:30-8:30, 12:00-12:45, 4:00-5:30pm Tuesday: 8:00-5:30pm
Wednesday: 7:30-8:30, 12:00-12:45, 4:00-5:30pm Thursday: 8:00-5:30 pm
Friday: 7:30-8:30, 12:00-12:45, 4:00-4:30pm Saturday thru Sunday: Closed
PN Documentation FAQ Page
Questions?
1.
Review your materials
2.
Visit the Documentation FAQ page located at
www.olympic.edu/nursing
◦ Click on the Practical Nursing Certificate of Specialization page
◦ Then click Documentation FAQ page for your answer.
3.
After completing the first two steps then email
nursing@Olympic.edu
with a list of questions.
Documentation Packets
We will review each document and
requirement within the packets
Packet 1: General Information Packet
(return today)
Packet 2: Documentation Packet
(return by
December 28, 4:00pm
)
Packet 3: Harrison Medical Center – Student
Nurse Information Packet
Documentation Packet Submission
Turn in ORIGINALS of your signed forms.
Keep a copy of all documentation for your
records. We do NOT make copies.
Incomplete packets will not be accepted
.
Turn in your
documentation packet in a Sheet protector. It really will fit!
Due date
Complete documentation packet is due
into:
1.
CertifiedBackground.com/Medical
Document Manager
Prior to
December 28, 2015, 4:00 PM
.
&
2.
Nursing Programs Administrative office
Olympic College
Nursing Programs
General Documentation Packet
(Green)
Includes:
1.
Documentation Acknowledgement
2.
Documentation Release Form (for clinical
partners)
3.
Student Information and Address Consent
Form
What will happen if I miss the
deadline?
Failure to turn in your complete documentation
packet
by
December 28, 2015
4:00pm
Provisional acceptance will be
forfeited
and slot
will be offered to another student.
No exceptions will be made.
Documentation Acknowledgement Form
(included with general packet)
Please review, sign and date.
Documentation Release Form
Allows release of information to clinical
agencies.
• Immunization Status; • Personal Health & Liability Insurance; • CPR (Health Care
Professional Level);
• Malpractice Insurance;
• Background Check; • Modules.
What do I do?
1. Complete and return the documentation release TODAY.
2. Complete your background check on CertifiedBackground.com at
home.
3. Print a copy of your completed background check and turn in with your
packet to the Nursing Programs office.
Student Information &
Address Consent Form
Complete entire document regardless of address
permissions. No blanks.
This is the ONLY address and phone information the
Nursing Programs receives.
Please update any name, phone, and address changes with the Nursing
Programs office as well as Registration & Records.
Permissions area is for the Nursing Students Directory.
Nametag Order: required for clinical.*
$8.15 each.You will be given instructions regarding payment at the
orientation, December 9th, 8:00-12:00pm
OC Nursing Programs
Packet #2: Documentation ~
Blue color
1. Student Health & Safety Requirement Checklist (CertifiedBackground/Medical Document
Manager )
2. Demographic Form
3. Student Mailbox Consent Form 4. Permission to Use Student Work
5. Naval Hospital Bremerton Agreement
6. Group Health Student Checklist for HIPAA; Confidentiality and Security Agreement
7. Harrison Medical Center Acknowledgement 8. Photo/Video Release
Certified Background.com
& Medical Document Manager
Service order will include:
Background Check:
Nationwide Sex Offender, Washington Statewide Criminal Search, Nationwide Federal Criminal Search, Residency History
Medical Document Manager
Proof of Immunity for Immunizations: TB Skin Test, Hep B, MMR, Varicella, Tdap, Influenza
Certified Background.com
Ordering Instructions
1. Go to www.CertifiedBackground.com and
click on "Students."
2. In the Package Code box, enter the package
code:
OL32PN
– Background Check +
Annual Medical Document Manager
$87.75
Submitting Documents to Medical
Document Manager
Submit your documents to
CertifiedBackground.com/Document
Manager via:
1.
Upload (similar to Facebook)
Accepts JPG or PDF.
What do I provide to OC from
Certified Background.com
& Medical Document Manager ?
1.A “To-Do-List Summary
Report” from Certified
Background/Medical
Document Manager
(instructions to download the report are in the packet)
2.
Completed background
check.
Please do not give us a copy of documents submitted to your
Medical Document Manager
Student Health & Safety Requirement Checklist
(Clinical Passport)
This document includes all requirements that are to be submitted to CertifiedBackground.com/Medical Document
Manager.
Immunizations (TB Skin Test, Hep B, MMR, Varicella, Tdap, Influenza)
Proof of Immunity is Required (By Titer or Vaccination Record)
Note: HEP B Requires vaccination record &/or titer CPR Card
**Proof of immunity required**
Proof of immunity:
•
Proof of immunity by titer. (blood test)
or
•
Proof of immunity by immunization/vaccination
record.
Note: HEP B Requires vaccination record & titer
Documentation MUST meet requirements at all times
during the program. It is your responsibility to keep all
documentation up to date (example HEP B Series).
Medical Document Manager:
Required Immunizations –
TB Skin Test
If no previous records or more than 12 months since
last TST → 2 step TST.
(2-step TB Skin tests require 4 visits to provider)
1. 1st step: Injection, return to read.
2. 2nd step: repeat injection, return to read, otherwise 1
step TST.
(typically within one week of 1st step completion, some
providers prefer a month between injections) OR
All TB Skin Tests results must cover the duration of the
TB Skin test…
Q: I had a skin test for TB last year, what is required for me?
You will need to complete a 1-step TB Skin test only in
December.
You will also need to provide proof of your TST from last year.
Note: If it was longer than 12 months since your last TST you will be required to get a two step TB skin test.
---Q: I tested positive what do I do?
1. You will need to provide documentation of: A negative chest x-ray showing no symptoms. TB health questionnaire.
And a signed note from your PCP approving clinical
Medical Document Manager:
Required Immunizations –
Hepatitis B
Series of 3 vaccines completed at appropriate time intervals
and post vaccination titer at 6-8 weeks after series completion.
o You must show evidence of beginning the series (first two immunization)
at least prior to the December 28th.
o You must continue to get the series and submit proof to Certified
Background while in the program. Series must be complete by end of spring quarter OR
Provide documentation of positive titer (anti-HBs) OR
If negative titer, then repeat series and repeat titer 6-8 weeks
after #6 dose – you will be allowed in fieldwork while undergoing this process.
Note: Specific healthcare institutions may require vaccination without exception.
Considered a non-responder to vaccination after 2 complete vaccine series and a
negative titer.
Signed waiver for students who decline vaccination. (must meet with Associate
Hepatitis B…
Not immunized yet?
Get your first immunization ASAP.
Series must be complete by the end of spring
quarter!
Immunization Timeline:
1
stimmunization
~ Early November
2
ndimmunization
~ 1 month later (early December)
3
rdimmunization
~ 6 months from the 1
st(early
May)
Medical Document Manager:
Required Immunizations
–
MMR & Varicella
MMR (Measles, Mumps, Rubella)
Proof of vaccination (2 doses)
OR
Proof of rubella, rubeola, and mumps immunity by titer.
Titer must show all sections of the MMR to be accepted.
***
Varicella (Chicken Pox)
Proof of vaccination (2 doses)
OR
Proof of immunity by titer.
Medical Document Manager:
Required Immunizations –
Tdap & Flu
Tetanus, Diphtheria & Pertussis
Vaccination must cover the duration of the program.
(from December to December 2016)
Td is not accepted.
***
Influenza
Both H1N1 & Seasonal immunizations are
required. Typically combined.
Proof of vaccination is required.
Note: In Fall 2016 – you will be required to update your
Medical Document Manager:
Additional Items–
CPR
CPR (Healthcare Provider Level)
Cards must read: Healthcare Provider & be from the American Heart
Association and cover entire duration of the program (December – December 2016). Red Cross CPR is not accepted.
Due to our clinical affiliation agreements CPR needs to be done
yearly by all students (even though it is issued for two years).
Your card must be signed and look like the card below.
The 1st year of the card is accepted only. Cards whose start dates are prior
CPR Suggestions
Note: You may find other organizations on your own that also provide certification for American Heart Association, be sure to check that the card issued will be from AHA.
*You may check our Nursing News webpage,
Medical Document Manager:
Additional Items –
Insurance
Insurance
Proof of Personal health insurance.
Suggestions:
Summit America Insurance Services
Malpractice Insurance (from Olympic College Cashier) must be dated for winter quarter. $19.85 One time payment.
Liability Insurance (from Olympic College Cashier) must be dated for winter all quarter. $2.50 One time payment.
Medical Document Manager:
Additional Items –
Modules
Instructions to Access PowerPoint Training Modules
All training modules are required: Infective Medical Waste, Standard
Precautions, Compliance (HIPAA), Emergency Response Procedure, Bloodborne Pathogens & Workplace Safety
Test score results are required for all modules.
*Pop-up blocker must be disabled*
1) Type, http://cpnorthwest.org
Select - Student login: Username: s0uthStud3nt
Password: s0uthnurs3!
2) Learning Modules will appear 3) Begin your learning modules
4) Print or take a screenshot of the results with your name printed for submission with your documentation to Certified Background.
Modules…
Example of Compliance module screenshot
Forms to be submitted to Nursing
Office
1.
Demographic Form
2.
Student Mailbox Consent Form
3.Permission to Use Student Work
4.
Naval Hospital Bremerton Agreement
6.Group Health Student Checklist for
HIPAA; Confidentiality and Security
Agreement
7.
Harrison Medical Center
Acknowledgement
8.
Photo/Video Release
D
OCUMENTATION
F
ORMS
-Demographic Form
Completion of the items with an asterisk
* is required for
Navy Security
.
Complete ALL areas of this form.
It is a part of the ongoing evaluation process
of the Nursing Programs and provides
valuable information for accreditation.
D
OCUMENTATION
F
ORMS
–
P
ERMISSION TOU
SES
TUDENTW
ORK& S
TUDENTM
AILBOXC
ONSENTP
ERMISSION TO
U
SE
S
TUDENT
W
ORK
Used for accreditation purposes.
S
TUDENT
M
AILBOX
C
ONSENT
Gives permission for faculty and staff to return
D
OCUMENTATION
F
ORMS
-
Naval
Hospital Bremerton Agreement & Harrison
Medical Center Student Acknowledgement
Navy Hospital Bremerton Agreement
Navy Civilian Trainee Agreement Fill out and return.
You will be going to Naval Hospital Bremerton for clinical
experiences. They require completion of this form.
Note: to apply for Navy Access all US citizens are required to present official
identification at Pass/ID (Valid US Passport, Enhanced Drivers License, or Certified Birth Certificate). You do not need to submit them to the Nursing Office.
***
Harrison Medical Center - Student Acknowledgement
D
OCUMENTATION
F
ORMS
-
Group
Health HIPAA & Video/Photo Release
Group Health HIPAA
1. Complete “Compliance” module.
2. Complete both sides of the HIPAA form.
3. Leave dates of clinical experience and instructor blank as these do change throughout the program.
4. Return with documentation packet to the Nursing Administrative office. We will send them to Group Health in bulk.
***
Video/Photo Release
Primary use: Video’s during simulation practice, etc. Please review, sign and date.
D
OCUMENTATION
F
ORMS
-
DSHS
Background Authorization
Print clearly with black ink.
Read each question carefully.
You MUST fill in ALL boxes on this form as
instructed. READ the instructions for each Section & each box.
You MUST put an answer in the box. You can put
NO, NOT APPLICABLE (N/A), OR NONE– except BOX number 3
DO NOT answer any question by putting
Packet # 3 -
Harrison Packet
(Blue)
Harrison Medical Center (HMC) requires the packet to be completed in preparation for clinical experiences at HMC. Please fill out
completely and clearly so it can be entered into HMC’s database.
The pages that need to be filled are:
Student Nurse Information Sheet
Make sure to answer the following questions:
Is there a Student Acknowledgement form to be signed? Yes / No Are you a current Harrison Employee? Yes / No
Were you a former Harrison Employee? Yes / No
Leave department, title, and dates blank
Review documents and initial the Harrison Checklist
Census Data
HMC Child and Adult Abuse Disclosure Statements Confidentiality Agreement
HIPPA Regulations (Read manual and return ONLY the Attestation) Service Standards (Sign & Date on the bottom of the form)
Student Acknowledgement form (attachment A)
Further Questions??
***** Due date
Can you submit the documents prior to the deadline of
December 28th?
Absolutely!
Take Away’s
Turn in TODAY
1. Documentation Acknowledgement
2. Documentation Release Form
3. Student Information and Address Consent Form
***
Turn into CertifiedBackground.com/Medical Document Manager
1. Proof of immunity for all immunizations
2. Background Check information
3. CPR card
4. Insurance (Malpractice, Liability, Health)
Take Away's….
Turn into Nursing Programs Administrative Office 1. Background Check Results from Certified
Background.com
2. To-Do-List Summary Document or Screenshot from Medical Document Manager showing approval for all documents submitted
3. Demographic Form
4. Permission to Use Student Work 5. Student Mailbox Consent Form 6. Naval Hospital Agreement
7. Group Health Student Checklist for HIPAA and Confidentiality and Security Agreement
8. DSHS Background Authorization
9. Harrison Medical Center Acknowledgement
PN Documentation FAQ Page
Questions?
1.
Review your materials
2.
Visit the Documentation FAQ page located at
www.olympic.edu/nursing
◦ Click on the Practical Nursing Certificate of Specialization page
◦ Then click Documentation FAQ page for your answer.
3.