ALLIED HEALTH STUDENT ONBOARDING CHECKLIST 2016/2017
This checklist must be be completed by the school coordinator 30-60 days prior to the clinical rotation start date.
Email completed paperwork to [email protected] or fax to 816-404-2003.
Date:___________________ School Name:_____________________________________ Degree/Year:_____________________
Student Name (with Middle Initial):_________________________________________________ DOB:_____________________
Field of Study: _________________________________________ TMC Clinical Instructor: ______________________________
Hospital Hill: ____
Lakewood: ____
Behavioral Health: ____
Other: ___________________________________________
REQUIREMENTS
COMPLETED
School - Program Accreditation Certificate
School - Liability Insurance on File
School - Clinical Education Agreement
Yes___
Yes___
Yes___
Start and End Dates of Clinical Rotation
Start:___________ End: ___________
Social Security Number – Last Six Digits
SS# XXX - _ _ - _ _ _ _
Background Check (per agreement)
Complete?______ Felony?______
Family Care Safety Registry, Go to: http://health.mo.gov/safety/fcsr/
Results will be emailed to student within a few days. (See more on page 2.)
Confidentiality Agreement (See page 3.)
TMC eLearning for Allied Health Students
Go to: http://www.webinservice.com/truman (See instructions on page 4.)
2 Step TB Testing (no other TB tests accepted)
- The first test must be within a year of the rotation start date. The second test must be
within 60 days of the rotation start date.
- If you have a history of a positive TB Skin test, then you must have a 2-view chest
x-ray report within the last year and a symptom review within 60 days of the rotation
start date.
- All TB tests or chest x-rays/symptom reviews must be negative.
Hepatitis B
Immunization dates and/or titer with the result and date.
No___
No___
No___
Scan results with checklist.
Scan signed form with checklist.
Scan transcript with checklist.
Step 1 Date:_______________
Step 2 Date:_______________
Dates:
Measles, Mumps Rubella and Varicella Immunizations
List two immunization dates for each or list titer date(s) and note POS for immunity.
MMR:
Tdap or Td booster within 10 years
Date:
Flu Shot
Date:
CPR (see list for required students)
Exp Date:
Varicella:
Student Contact Information
Home Address: ___________________________________________________________________________________
Phone Number: _________________________
Email: __________________________________________________
School Coordinator/Representative
Signature is required to verify all of the above items are part of the student’s file and available upon request.
Name (print):_____________________________________ Signature:________________________________________
Title_________________________ Contact Phone #:__________________ Email______________________________
FAMILY CARE SAFETY REGISTRY
Missouri's Family Care Safety Registry (FCSR) was established by law to promote family and community safety. The
registry helps to protect children, seniors, and the disabled by providing background information. Families and
employers can call the registry's toll-free line to request background information on registered child care, elder care, and
personal care workers or to request licensure status information on licensed child care and elder care providers. This
service is intended to provide information to help families and employers make informed decisions when hiring
employees to work with children, the elderly, and the disabled.
To register go to: http://health.mo.gov/safety/fcsr/.
1. You will be charged a nonrefundable $12.00 registration fee and an additional $1.25 processing fee.
2. Once you have registered, you will receive an email within a few days from FCSR with the subject, “Family
Care Safety Registry Correspondence for NAME.” Click the “SecureMessageAtt.html” attachment in order to
create a login/password to access your results.
3. Scan a copy of the results with the checklist.
If you have already registered and do not have your results:
• Call FCSR at 866-422-6872 to request your results. See steps 2 and 3 above.
CONFIDENTIALITY AGREEMENT
Patient, employee and TMC information from any source and in any form is confidential. In my job
I may have access to and receive such confidential information. I shall protect the privacy and
confidentiality of patient, employee and TMC information and shall limit my access to only the
minimum of confidential information necessary to accomplish my job.
I agree that:
• I will only access information needed to accomplish my tasks.
• I will not disclose copy, sell, modify or discard any confidential information unless it is part of my
job to perform any of these tasks. If it is part of my job to perform any of these tasks, I will follow the
correct corporate/department procedure to perform the task.
• I will not misuse any confidential information.
• I will keep my computer password(s) secret, and change it (them) regularly.
• I will not use anyone else’s password to any computer system at TMC.
• I will not share any confidential information even after my work at TMC is ended.
• I am aware that my access to confidential information may be audited.
• I will tell my supervisor if I think someone knows or is using my password(s).
• I know that confidential information that I learn on the job does not belong to me.
• I know that my access to the corporation’s computer systems may be revoked at any time.
• I will follow the TMC Corporate Confidentiality Policy and Information Security Policy.
• I understand that if I fail to comply with this agreement or abide by TMC Corporate Policies and
Procedures that I may be subject to disciplinary action including up to discharge, loss of privileges
and/or revocation of contract.
By signing this confidentiality statement, I agree that I have read, understood and will comply with this
statement.
Printed Name
Signature
Date
TMC eLearning
To access the online training, go to www.webinservice.com/truman.
Step 1: Self Register by clicking “click here.”
Step 2: Create a new account by clicking “click
here.
Step 3: Follow the on-screen instructions.
• Under "Primary Relationship to Truman”
choose:
“Allied Health Students”
Complete Lessons/Tests – On your Personal Page, next to My eLearning Lessons, click “View” for your six lessons:
1. TMC: Training Introduction (no test)
2. Abuse/Neglect Grievance Resolution
3. TMC: General Compliance Training
4. TMC: Information Security Policy
5. Truman Medical Center HIPAA 101: Privacy Training
6. Student Orientation Training
Print Your Transcript (must include with paperwork):
• Once all lessons are complete, click on the “Home” tab, then “My Personal Page” (top left).
• Under Reports, next to My Transcript – All Training, click “View” (second from the bottom).
• Status should show six green checkmarks. Print, or Export to Excel and convert to PDF to add to paperwork electronically.
Helpful Hints:
• Once you complete a lesson, if you do not see the option “Take Test” you will need to close the lesson and return to the
“Assigned Items” screen. Click on the lesson again in order to click “Take the Test.”
• If you are interrupted for any reason and need to leave the lesson, you can return to where you left off. If you are in the
middle of the testing portion of a lesson and must log off, you will receive a zero for that particular test, but you will be able to
go back and re-test to change the score.