Course Syllabus ORTH 3010 Topics: Ocular Motility I Fall Semester, 2012 4 semester credits Contact hours: 60 lecture Mondays 3:15 – 5:00 pm Tuesdays 3:25 – 5:00 pm Old Main, 1st floor, Room 103 HENRIETTA SCHMOLL School of Health Orthoptics Prerequisite: accepted student in Orthoptic major Faculty Information Name: Lisa P. Rovick, MHSc, CO, COMT Office location: Minneapolis Campus. Old Main #401 Phone: 651-690-7778 Cell: 612-716-4418 E-mail [email protected] Office Hours: Mondays 10:00 – 12:30 (beginning October 1); by appointment Course Description (from catalog) This course introduces you to ophthalmology, including the role, duties and responsibilities of the orthoptist. Ethics, professional associations and certification, and patient privacy and confidentiality (HIPAA) will be discussed. You will be introduced to the structure and function of the human visual system including the globe, orbit, ocular adnexa, extraocular muscles, conjunctiva, cornea, iris, pupil, angle structures, ciliary body, crystalline lens, vitreous, retina, optic disc, optic nerve, visual pathway and neuro-anatomy. Binocular vision, vision development and abnormalities such as amblyopia, neurologic control of eye movements and abnormalities will be discussed. You will learn and practice the elements and techniques of a basic sensorimotor evaluation, including evaluation of sensory status and measurement of eye alignment and eye movements. This course will also include completion of a programmed text in medical terminology. Course Goals The overall goals for this course are to provide a knowledge and skill base upon which all of the additional courses in the orthoptic major are built: Course Goal Liberal Arts Goal 1. Describe the structures and functions of the eye and visual pathway. Discipline-Based Competence 2. Describe fundamental concepts of eye movements and binocular vision. Discipline-Based Competence 3. Explain and demonstrate basic skills involved in an ocular and Discipline-Based Competence sensorimotor examination. 4. Research the published Pediatric Ophthalmology and Orthoptic literature. Critical and Creative Inquiry 5. Prepare and present findings of the above research to an audience. Effective Communication, Lifelong Learning LIBERAL ARTS GOALS Ocular Motility I (ORTH 3010) advances the attainment of the University’s “Goals of a Liberal Arts Education”, generally, as this course prepares students to explore the nature of critical thinking in Orthoptics. Additionally, the following liberal arts goals are met in this course: Leadership and Collaboration Ethics and Social Justice Diversity and Global Perspectives Critical and Creative Inquiry DisciplineBased Competence Effective Lifelong Communication Learning Students collaborate in the preparation of the Evening Seminar presentations and other group projects during the semester. During case discussions students are reminded about respectful approach and sensitivity to patients with varying levels of ability. Cultural differences are addressed in the context of case discussions -research and discussion of topics that apply to the discipline of Orthoptics. -Students learn the underlying pathology of strabismus. -Presentation at monthly Evening Seminars -Selection of appropriate examination techniques in the evaluation of the pathology introduced. Participation in monthly Evening Seminar, a continuing education event. Learning Outcomes Student Learning Objectives Instructional Upon successful completion of this Strategy Method of Assessment course, you will be able to: Describe the structures and functions Lecture, anatomy lab Weekly quiz, midterm and final of the brain, eye and orbit including: direct identification, examinations. Eye model project. In the anatomy lab: a. group project identify the major structures of the brain 1. b. identify and trace the structures involved in the visual pathway from the optic nerve c. identify cranial nerves II, III, IV, V, VI as they exit the brain stem 2. Deduce the meaning of a medical term Programmed text, Weekly quiz, midterm, final through the understanding of the classroom discussion. examinations. Discuss the development of vision, the Lecture, discussion, Weekly quiz, midterm and final concepts of binocular vision and simulation examinations. List the elements and demonstrate Lecture, discussion, Weekly quiz, midterm and final proper technique used in the simulation examinations, clinical skill checklist. Discussion Weekly quiz. Describe ethical clinical practice, as Discussion, role- Midterm and final examinations. outlined in the Orthoptic Ethics playing structure of medical terminology 3. amblyopia. 4. assessment of visual acuity, binocular vision and eye alignment. Describe the different subspecialties 5. within the field of eye care and the patient populations served by each. 6. Statement. 7. Summarize, through a PowerPoint Presentation, lecture, presentation, assigned peer reviewed discussion, journal articles and select appropriate supporting documentation to support these findings. Student peer review Teaching/Learning Activities: Instruction/facilitation methods include lecture, demonstration, skills laboratory sessions, and case-study learning. Evaluation methods include written examination, writing exercises and assessment of Evening Seminar presentations. Percentage of final grade Participation Includes class and small group discussions 1. Weekly Content quiz Weekly content quiz (based on material presented and discussed during previous week) 10 pts./quiz 25% 2. Eye Model Group Activity 5% Students will design and build a working model of a globe, with all extraocular muscles and their respective cranial nerves, suspensory ligaments and other structures involved in the rotation of the globe in the orbit. 3.. Monthly Evening Seminar presentation 10% -Preparation of presentation (clarity, logical sequence, citations present) 20% -Demonstrates understanding of material presented 30% -Clarity of presentation 30% -Evaluations from audience and peers 20% 4. Midterm and Final Examinations written comprehensive 30% per exam examination at midterm and end of semester Grading Policies The final course grade for Ocular Motility I (ORTH 3010) is as follows: Final Percentage Final course grade 90 – 100 A 80 – 89 B 70 – 75 C 60 – 74 D < 60 F A final percentage of 75 or greater in this course is required for continued enrollment in the orthoptic major. Exceptions to this rule may be made at the discretion of the program director. ASSIGNMENTS: All students are expected to turn in assignments by the DUE dates. Every assignment for this class must be completed in order to receive a final grade for the course. It is your responsibility to contact the course instructor in advance of the due date, if you are struggling with an assignment or if you need an extension. EXCUSED ABSENCES: Make up course requirements (exams, quizzes, projects, etc) must be rescheduled at a mutually convenient time. It is your responsibility to arrange a make-up schedule with the course instructor IN ADVANCE. UNEXCUSED ABSENCES: make-up course requirements that were missed must be completed by the student within three (3) school days of their original date. If not completed within this time frame, the total point value of the course requirement is forfeited. INCOMPLETE GRADES: “A grade of incomplete is given only when unusual circumstances deem it appropriate. Ordinarily, such circumstances would involve matters that are not wholly within a student’s control, such as illness. If you wish to receive an incomplete grade you must complete a Petition for Incomplete Grade form (available online http://minerva.stkate.edu/RecOffFrms.nsf/Incomp4?OpenForm ) no later than the last day of the term in which course requirements are due. You must be making satisfactory progress in the course and you must have completed 75% of the course at the time the petition is filed. Incompletes are awarded at the instructor’s discretion. If granted, the normal deadline for completion of work is no more than eight weeks after the last day of classes in the session or sub-session in which the course is offered. The instructor may establish a due date after the normal deadline if you request it and special circumstances warrant it. The instructor will submit an alternate grade that will automatically be recorded if you do not complete the requirements for the course by the deadline. If you complete the course requirements in the time allotted, the instructor must submit the final grade by the deadline. Extensions to the due date originally agreed to by you and your instructor must be approved by the appropriate academic dean.” (Petition for an Incomplete Grade, from St. Catherine University Catalog). REQUIRED EVALUATION ACTIVITIES PERCENTAGE OF GRADE Weekly content and Medical Terminology quizzes 25% (the lowest scoring quiz in each section will be dropped) Eye model group activity 5% Evening Seminar presentations 10% Midterm examination 30% Comprehensive final examination 30% TOTAL 100% Textbooks and Other Required Materials REQUIRED: Medical Terminology… A Programmed Systems Approach 9 th edition revised (there is a new edition out this year….we’ll use 9th edition…less expensive) Authors are Dennerll, Jean Tannis & Davis, Phyllis E. ISBN: 14180-2021-4 JCAHPO/ATPO Pocket Guide order this from the JCAHPO web site. http://www.jcahpo.org/pdfs/Pock_Guide_Order_Form.pdf Handbook of Pediatric Strabismus and Amblyopia Wright, K., Spiegel, P, & Thompson, L. ed Springer 2006. ISBN: 0-387-27924-5 e-ISBN: 0-387-27925-4 Fundamentals for Ophthalmic Technical Personnel. Cassin, B. W. B Saunders, 1995. ISBN: 0-7216-4931-9 Binocular Vision And Ocular Motility. vonNoorden, Gunter Available online (you may print your own copy, if you prefer to read on paper) through Cybersight: http://www.cybersight.org/bins/content_page.asp?cid=12193 Purchase from instructor: Orthoptic Syllabus $100.00 The Orthoptic Basic Science Lecture Series on DVD, with manual $75.00 Basic Clinical & Science Course. Section 5 (Neuro-Ophthalmology). Published by the American Academy of Ophthalmology ISBN: 978-1-61525-294-7 ~$90.00 (you’ll get this a bit later in the semester) OPTIONAL: Management of Strabismus and Amblyopia A Practical Guide second edition. Pratt Johnson, Tillson ISBN: 086577-992-9 (you don’t need to purchase this one, but it’s a good one to have) Clinical Orthoptics, 2nd ed. Rowe , Fiona. Blackwell Publishing, 2004 ISBN: 1-4051-1342-1 (this is a required text for the spring semester) Learning Resources • This is a Desire 2 Learn supported course. Course documents will be uploaded to this portal, which may be accessed at: https://stkate.desire2learn.com/ Your USERNAME and PASSWORD will be the same as in KateWay. If needed, please call the HELP DESK at 651-690-6204. • It is your responsibility to check D2L DAILY for messages, updates, assignment folders, websites, and other support material for this course. ATTENDANCE St. Catherine University defines attendance as participating in the faculty and student interaction required by the course. Regular attendance is expected of all students. Students are expected to arrive at class on time and stay for the duration of the class. Students, whether present or not, are responsible for in–class content and class assignments (see Assignments section). Absences for any reason will be taken into account in the evaluation of the student’s work. If you cannot get to class (e.g. illness, car won’t start, relative dies), contact the instructor before class begins. Instructors must be informed about any absence before class or it will be unexcused. Students who do not attend class on the first day of class will be withdrawn from the course by the Registrar’s Office. Even if the student does not attend class meetings, the student remains financially responsible for paying tuition for the course, up to the date of formal withdrawal. The deadlines for adding, dropping and withdrawing from a course are found on the Academic Calendar (on Kateway). ACCOMODATIONS Saint Catherine University is committed to equal access for all and recognizes that disability is an aspect of diversity. The University’s goal is to create learning environments that are usable, equitable, inclusive and welcoming. If there are aspects of the instruction or design of this course that result in barriers to the learning environment, accurate assessment or your achievement, please contact the Resources for Disabilities office as soon as possible. Access Consultants can be reached in the O’Neill Center at 651-6908160 to discuss academic adjustments or accommodations. ACADEMIC INTEGRITY POLICY The mission of St. Catherine University provides for excellence in education through the search for truth and justice. In accordance with the mission, the University expects all students and faculty to uphold the highest standards of academic integrity, and acts of academic dishonesty will not be tolerated. Academic dishonesty includes, but is not limited to, the following examples of conduct: violating the academic rights of another student; cheating on assignments or exams, including the use of crib notes or other unauthorized materials; submitting papers or assignments written by another person (student, commercial agency, etc); copying from another student's paper; stealing copies of exams or answer sheets; conveying test items to other students; plagiarizing on papers and other assignments; consenting to have one's work used by another student as her/his own; falsely reporting information or misrepresenting actions in clinical or classroom laboratories; depriving other students of necessary course materials by stealing books, periodicals or other materials from the library, media center, labs, etc.; submitting the same paper, or substantially similar papers, to meet the requirements of more than one course without approval of the appropriate instructors; interfering in a harmful way with another student's work, such as sabotaging another student's laboratory experiment or entering or deleting data in another student's computer account or unlawfully duplicating copyrighted materials. CONDUCT AND ACADEMIC INTEGRITY PLEDGE Each student is expected to adhere to all Orthoptic Program Student Policies and Procedures including the following Conduct and Academic Integrity Pledge. I, _______________________________________________________, pledge to uphold the ideals of St. Catherine University that learning be pursued in a spirit of excellence, life be lived with a commitment to values of justice and caring, and leadership be carried out appropriately, actively and positively. Having read the Orthoptic Ethics Statement and the Policy on Academic Integrity, I hold myself bound to respect and obey it in all matters of personal conduct and academic integrity. (Students will be asked to sign this learning contract at the beginning of the Orthoptic Program to indicate their acceptance of these expectations.) REAFFIRMATION OF CONDUCT AND ACADEMIC INTEGRITY PLEDGE I re-affirm the St. Catherine University Orthoptic Program Conduct and Academic Integrity Pledge for this evaluation activity. Student signature ______________________________________________ Date ______________ (This Reaffirmation of Conduct and Academic Integrity Pledge will be included on all exams, tests and written assignments, with the student’s signature and date, indicating their adherence to this pledge.) When academic dishonesty is alleged, the faculty member will immediately discuss with the student the grounds for suspicion and educate the student about the academic integrity policy and the consequences for violating the policy. If the faculty member determines that a violation has occurred, she/he will check with the Academic Affairs Office on her/his campus to inquire if the student has been reported previously for violations of the Academic Integrity Policy. The Academic Affairs Office maintains a database of past offenses; however, these notations do not become a part of a student's permanent academic record unless they are the basis for expulsion from the University. The faculty member will forward a description of the violation, a copy of the evidence, and a proposed sanction to the Academic Affairs Office. The Associate Dean for Academic Affairs Bonnie LaDuca, as well as the faculty member's department chair or program director, will be available to consult with the faculty member regarding an appropriate sanction, based in part on the severity of the infraction and whether the student had a prior history of such offenses. Faculty-determined sanctions will generally involve a reduced grade or zero credit on the assignment, test, or project or a reduced or failing grade in the course. For very serious offenses, the department chair or program director may impose the penalty of dismissal from the student's academic program. For the most serious offenses, the academic dean or her/his designee may impose the penalty of academic suspension or expulsion from the University. For a more detailed explanation of the Academic Integrity Policy, consult the online Le Guide: Student Code of Conduct and Community Expectations. Pay particular attention to sections III. Code of Conduct, IV. Sanctions resulting from Code violations, and VIII. Academic Integrity. Faculty members can find additional guidelines on the Academic Affairs website. Tentative Class Schedule (subject to change, as needed) Ocular Motility I Fall Semester 2012 Week topic Homework/readings Mon, 9/10 Skull, orbits, brain, Med Term Unit 1 blood supply Cassin Chapters 2-3 http://memo.cgu.edu.tw/cgmj/3303/330310.pdf ongoing throughout the semester: Orthoptic Basic Science Series DVD: Ocular Anatomy Orthoptic Syllabus p. 2-3,10-12 Tues, Globe, muscles, nerves, Med term quiz vonNoorden Chapter 3,6 9/11 cranial nerves unit 1 Cassin Chapter 1, 6, 10, pg. 307-308 Wright Chapter 2: pp 24-60 Orthoptic Syllabus p. 7-9, 12-14 Mon. 9/17 Eyelid, tears, conj. & Med Term Unit 2 cornea Cassin p. 3-6, 397-399 Orthoptic Syllabus p.3-5 Tues, Fixation, Eye Med Term quiz Cassin pg 161-163, 278-279, Chapter 21 9/18 movements, Hering, unit 2 Wright Chapter 2: pp 61-67 Sherrington Laws, ongoing throughout the semester: Orthoptic Basic Science Series DVD: Oculomotor Physiology of the Eyes positions of gaze, axes Syllabus p. 24-26 of rotation (Fick, etc) Mon, Tenon’s, episclera, 9/24 sclera, angle Med term unit 3 Cassin p.6-8, 406-418 Syllabus 5-6, 17-18 structures, uvea Tues, Visual development, Med term quiz Cassin pg. 157-163 9/25 age-appropriate vision unit 3 Wright Chapter 1: pp 1-12, Chapter 4 testing vonNoorden Chapter 14 Article: Dissociation of processing of featural and spatiotemporal information in the infant cortex http://www.sciencedirect.com/science?_ob=ArticleURL&_udi=B6WNP-50G06781&_user=1822421&_coverDate=07%2F05%2F2010&_rdoc=1&_fmt=high&_orig=search&_sort=d&_docanchor=&vi ew=c&_acct=C000054564&_version=1&_urlVersion=0&_userid=1822421&md5=4bf825352d72b0bc5171c7ba36e ac689 ongoing throughout the semester: Orthoptic Basic Science Series DVD: Amblyopia Mon, 10/1 Lens, vitreous, retina, Med term unit 4 color vision, optic Cassin Chapter 5, p.397, 424-426 Syllabus p. 6-7, 12 nerve Tues, Tropia/phoria. Basic Med term quiz Cassin Chapter 20 10/2 types of strabismus unit 4 Wright Chapter 3: pp. 84-94 (includes Dissociated Syllabus strabismus) Mon, 10/8 Tues Clinical Discussion Med term unit 5 Cassin Chapter 7, 16 Visual pathway, visual Syllabus fields, pathology ongoing throughout semester: Orthoptic Basic Science DVD: Neuro Anatomy Evening seminar prep. 10/9 Med term quiz Evening seminar prep. and practice unit 5 Mon, Clinical Discussion 10/15 Cover tests, corneal Med term unit 6 Cassin Chapter 20 Wright Chapter 5:pp. 143-160 reflex tests Syllabus (Hirschberg/Krimsky) Recording results Mon. 10/15 Evening Seminar 6:30-8:00 pm AMBLYOPIA (anatomy & physiology of amblyopia, types of amblyopia, traditional/historical treatment, treatment recommendations from ATS studies, looking to the future; clinical pearls) Tue, Review 10/16 No med term quiz. Review: 3-4 pm Midterm Exam: 4-5 pm MIDTERM EXAM Two part examination: Part 1: Ocular A&P, terminology through unit 6 (30 points) Part II: Ocular Motility topics Mon, Clinical Med Term unit 7 BCSC Neuro Ophth. Pg 20, 27-37, 10/22 Discussion 50-55, Chapter 11 Neuroanatomy Cassin Chapter 6, 8, 10 intro (circle of Willis, cranial nerve pathways, chiasm) Tues, Sensory fusion, 10/23 motor fusion, Med term quiz unit 7 CASSIN pg. 278-282 Wright Chapter 3: pp. 70-83, Chapter 6: pp 174-188 Panum’s area, Basic Science Series DVD: Abnormal Binocular Physiology of the Eyes monofixation, retinal correspondence Mon, Clinical 10/29 Discussion Med term unit 8 BCSC Neuro Ophth pg 48-49, 52 Cassin Chapter 8 More Neuroanatomy Cerebellum Tues, Fusional 10/30 amplitudes, Med term quiz unit 8 Cassin pg 15, 139-145, 170, 194-195, 282-287 Wright pp. 90-100 accommodative vonNoorden amplitudes, Near reflex Mon, 11/5 Clinical Discussion Pons and cranial nerve nuclei EYE MODEL DUE Med term unit 9 Cassin Chapter 10 BCSC pg. 51-62 Tues, Diplopia: 11/6 monocular, Med term quiz unit 9 BCSC Chapter 8 Wright pp. 174-178, 188-204 binocular Diplopia vs confusion Mon NO LECTURE NO LECTURE (make up = Evening Seminar) 11/12 Tues, Please go to assigned clinic NO LECTURE NO LECTURE (make up = Evening Seminar) 11/13 Please go to assigned clinic Mon, Clinical 11/19 Discussions Med term unit 10 Cassin Chapter 9 BCSC pp. 37-41, Chapter 7 Introduction to Wright pp. 423-440 paralytic and supranuclear disorders (neuro ophthalmic disorders) Tues Evening Seminar 11/20 Prep Mon Cadaver lab 11/26 session Clinical Med term quiz unit 10 Evening Seminar Prep Med term unit 11, 12 Meet in St. Paul Neuro anatomy review Discussion Ocular and orbital anatomy dissection (guided) Pupil function, Video: http://www.medicalvideos.us/play.php?vid=87 includes pupil pathway Mon. 11/26 Syllabus p. 17-18 Evening Seminar 6:30-8:00pm VISION SCREENING DEBATE Olivia McKinley, Laura Olson, Rhea Curtis screening vs. comprehensive eye exam Dimitra Triantafilou, Emily Dockendorf, Trish Walsh photoscreening vs. critical line testing Tues, Pupil disorders, Med term quiz unit 11, 11/27 testing 12 Mon, 12/3 Clinical Med term unit Cassin Chapter 22 13, 14 BCSC Chapter 13, pg 247 Med term quiz 13, 14 Cassin pp. 286-287 Review Discussion Torticollis: BCSC Neuro-Ophthalmology (Section 5) Chapter 15 starting page 169. Watch YouTube videos on Horner’s, APD, Adies, normal pupil testing, neutral density filters for grading APD ocular and nonocular Non-organic (Functional) vision loss Tues. Spectacle 12/4 problems related to strabismus, prism correction Mon. Final Exam Med term unit 15 + 12/10 review review Tues, Evening Seminar Med term quiz unit 15 12/11 Prep Date TBD FINAL EXAM (written) Evening Seminar prep Final exam review session, if time 2 parts: Ocular A&P + Terminology 1 hour Ocular Motility 1 hour Mon. Evening Seminar 6:30-8:00 pm 12/17 Evidence-based orthoptic practice Speakers: Olivia McKinley, Trish Walsh Cochrane studies of X(T) Rhea Curtis, Dimitra Triantafilou Emily Dockendorf, Laura Olson: Cochrane studies of amblyopia therapy J-term January 2-31, 2013 Happy New Year! Report to your clinic. Please contact your assigned clinic and make arrangements for the first day Anatomy Lab Students in the course will have the opportunity to have a session in the anatomy lab after studying the structures of the brain in the classroom and in text and diagrams Prior to attendance in the anatomy lab, students will complete training in the required protocol and other lab procedures Consent and protocol forms are below. The link to the orientation video is http://mediamill.cla.umn.edu/mediamill/embed/18412 POLICIES REGARDING ANATOMY LAB USE BY STUDENTS, FACULTY & STAFF With regards to anatomy lab participation at St. Catherine University, students, faculty and staff are required to follow these policies. 1. No cell phones and/or cameras are allowed in the laboratory. Videotaping or photographing the human anatomical material is strictly prohibited without the prior consent of St. Catherine University’s anatomy lab director and the Anatomy Bequest Program Proposal Review Committee at the University of Minnesota, including but not limited to any images which will published or distributed. 2. Students, faculty and staff shall track all loaned human anatomical material by keeping the donor’s acquisition number tag with the donor at all times during the loan. If the tag becomes disassociated from the donor, the course instructor should be contacted immediately, who then will notify the St. Catherine University anatomy lab director. All tissue removed from the donor during dissection must be retained, identified with the donor’s acquisition number, tracking during the loan and returned at the completion of the loan. 3. Anatomical material must not be removed from the dissecting laboratory. 4. Only registered students, teaching assistants and faculty/staff members can access the human donors and/or anatomical material. Visitors and guests are not allowed unless a written request for access is granted by the St. Catherine University anatomy lab director. 5. Both conversational and written language relating to the donor and donor dissection by human anatomy lab students, faculty and staff should be respectful and discrete. Any information about the donor including the donor’s demographical, social or medical history is confidential and students, faculty and staff are not allowed to disclose this information. 6. The use of the Internet in general, and social media sites in particular, including, but not limited to, Facebook, MySpace, Twitter, etc., by students, faculty and staff as a venue for discussing any aspect of the donor or donor dissection is strictly prohibited. 7. Doctor of Physical Therapy Program and Physician Assistant program students: Any student who wishes to access the lab after standard business hours is required to have at least one other student in the same academic program present with them at all times in the anatomy lab. 8. Non-compliance with the above policies may result in a student being immediately expelled from the course with a failing grade. Students, faculty and staff who are not in compliance with these policies may be referred for further disciplinary actions such as a conduct review hearing, and/or criminal charges, as applicable. January 2013 St. Catherine University - Human Anatomy Lab Orientation video from the University of Minnesota Anatomy Bequest Program Each St. Catherine University student utilizing the Human Anatomy Lab is required to view the following orientation video and then print off and sign the disclosure form and return it to their faculty member PRIOR to accessing the Human Anatomy Lab for the first time. http://mediamill.cla.umn.edu/mediamill/embed/18412 Anatomy Bequest Program Human Anatomy Access Orientation Disclosure Form The opportunity to review and dissect the human body is a privilege afforded to only a limited number of individuals. It carries with it an important responsibility for treating the person who has given his/her own body to advance your education and research with utmost respect and dignity. It is important that each individual appreciate the opportunity afforded and observe the policies outlined in the Anatomy Bequest Program Human Anatomy Access Orientation. These policies have been set up to promote respect for the donor and success for you in the laboratory. Failure to adhere to these rules may result in your eviction from the Anatomy lab. Please read the following statements and place a check mark in the respective boxes to signify your compliance and comprehension of the rules. In order to have access to the human anatomical materials provided by the Anatomy Bequest Program, I verify that I have taken part in a Human Anatomy Access Orientation session either in person or by video. I understand that my access to the human anatomical materials is a privilege, and all donations have been made by consenting individuals and/or families to better aid in anatomy education and research. I understand that it is my responsibility to adhere to the policies of the Anatomy Bequest Program and additional laboratory policies outlined in the course syllabus or proposal form. I understand that failure to comply with the established rules and policies regarding human anatomical materials may result in my eviction from the anatomy lab. I also verify that to the best of my knowledge I do not know any Anatomy Bequest Program whole body donors who have died within the last two years. If a donor is known, please leave this box unchecked, and fill in the donor’s name: _____________________________________________ This disclosure form is to be signed, dated, and returned to the course/lab instructor for filing. Print Name Sign Name Date
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