MEDICAL ASSISTING PROGRAM APPLICATION INSTRUCTIONS AND ESSENTIAL FUNCTIONS SELF ASSESSMENT 2015

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1 MEDICAL ASSISTING PROGRAM APPLICATION INSTRUCTIONS AND ESSENTIAL FUNCTIONS SELF ASSESSMENT 2015 Application Instructions Use this document as a check list and reference when gathering information for your application. You will need to submit all application documentation and forms via the Medical Assisting Application Portal in Canvas by 5:00 pm on June 1. The applicants accepted into the Medical Assisting Program will receive an acceptance letter with their entry codes for fall quarter registration, background check instructions, and mandatory New Student Orientation information by July 1 st. Students that are not accepted will also receive letters by July 1 st. Late applications will be evaluated on a space-available basis, with no guarantee of admission. Your personal essay and demographic information will be two files on one submission in the Canvas course. Your immunization information will be several files, or one combined file, in one submission in the Canvas course. Your acknowledgement forms will be several files, or one combined file, in one submission in the Canvas course. Detailed submission instructions are posted on the Canvas course. To submit your application: 1) Register for the Canvas application course, item number ) Contact the Program Director to schedule an appointment for Academic Planning 3) Contact Student Services to be added to Program Director s Advisee List and to be have your Program of Study intent code changed one of our two degree options 4) Submit all required documentation and forms to the Canvas drop-boxes by deadline 5) If accepted, attend mandatory New Student Orientation before fall quarter begins Essential Functions of Medical Assisting Students Essential functional abilities relates to the behavioral and physical components of student competence. They are abilities essential for safe patient care. Students should evaluate themselves to determine if they can meet the requirements of the profession. Students can contact Melissa Delikat in Student Development to discuss any ADA accommodations they may be eligible to receive that will enable them to meet these essential functions of the profession. 1

2 Sense/Skill Visual Auditory Tactile and Olfactory Communication Interpersonal Relationships Cognitive Ability Motor Function Essential Function 1. Observe and discern subtle changes in physical conditions and the environment 2. Visualize different color spectrums and color changes 3. Read fine print 4. Read data displayed on monitors/equipment 5. Detect non-verbal communication 1. Distinguish muffled sounds heard through a stethoscope 2. Hear and discriminate high and low frequency sounds produced by the body and the environment 3. Effectively hear to communicate with others 1. Discern tremors, vibrations, pulses, textures, temperature, shape, sizes, location and other physical characteristics 2. Detect body odors and odors in the environment 1. Verbally and in writing engage in two-way communication in English 2. Use qualified interpreters when appropriate to communicate with non-english speaking patients 3. Interact effectively with others from a variety of social, emotional, cultural, and intellectual backgrounds 1. Work effectively in groups/teams 2. Interpret non-verbal communication 3. Express ideas and feelings in a clear manner 4. Demonstrate behaviors that are age appropriate in relation to the patient 5. Convey caring, respect, tact, compassion, diplomacy, and empathy to patient and others 1. Operate a computer to obtain, enter, and transmit data 2. Effectively read, write, and comprehend the English language 3. Consistently and dependably engage in the process of critical thinking in order to formulate and implement safe and ethical decisions in a variety of situations and settings 4. Demonstrate satisfactory performance on written examinations, including mathematical calculations and medical terminology 5. Function effectively in situations of uncertainty or stress 1. Handle small objects and delicate equipment/objects without extraneous movement, contamination, or destruction 2. Move, position, transfer, and assist with lifting and ambulation without injury to patients, self, or others 3. Maintain balance 4. Coordinate hand/eye movements 5. Lift and/or carry objects weighing up to 25 pounds independently without injury to patient, self, or others 6. Lift and/or carry objects weighing up to 50 pounds with assistance without injury to patient, self, or others 7. Stand, bend and walk for prolonged periods of time while performing physical activities requiring energy without jeopardizing the safety of patients, self, or others 2

3 STEP 1: APPLICANT DEMOGRAPHIC INFORMATION Full Name: Peninsula College Student ID Number: Current address: City: State: ZIP Code: Home Phone: Cell Phone: Work Phone: Address: I have a High School Diploma Yes No I have a GED Yes No I have attended Peninsula College in the past. Yes No I have a degree in another discipline Yes No List degrees and certificates you have earned. Include the name of the College or University. 3

4 STEP 2: PERSONAL ESSAY INSTRUCTIONS Instructions Answer the following questions in essay form. Please make sure each part of the questions are addressed in your answers. Use Times New Roman, 12 point font and double space the body of the essay. No headers, footers, titles, numbering, dates, or labeling information is necessary on the essay itself. Follow the detailed submission instructions on the Canvas course. Save your work as a doc or docx file and submit it through the Canvas drop-box. 1) Why do you want to attend the Peninsula College Medical Assisting Program? 2) Have you worked in the medical profession? If the answer is yes, where and when, and in what capacity? 3) What are your goals for the next two years? 4) What are your educational goals? (For example, earn a degree or certificate, prepare for a job, or personal enrichment). 5) How do your goals involve team work? 4

5 STEP 3: REQUIRED IMMUNIZATIONS Applicants are required to submit proof of immunization electronically through the Canvas drop-box. Students should scan their paper documentation and submit their immunization records as pdf, tif or jpg files. Students can contact the Computer Lab for help Hepatitis B record of series of three injections OR titer that demonstrates immunity. 2. Measles record of two doses OR titer that demonstrates immunity. 3. Mumps record of two doses OR titer that demonstrates immunity. 4. Rubella record of two doses OR titer that demonstrates immunity. 5. Tetanus record of booster dose (TDaP) within ten years OR titer that demonstrates immunity. 6. Varicella record of two doses OR titer that demonstrates immunity. 7. PPD annual TB skin test documentation. If positive, student must obtain a chest x- ray with written results or signed statement from a healthcare provider stating student is asymptomatic and poses no danger to patients. 8. Influenza annual influenza immunization required. 5

6 STEP 4: REQUIRED ACKNOWLEDGEMENT FORMS Download the following three forms, complete and sign them, then scan the signed documents and submit them to the Canvas drop-box as pdf, tif, or jpg files. Students should scan their acknowledgement forms and submit them as pdf, tif or jpg files. They can be submitted as one combined file or as three separate files in one submission. Students can contact the Computer Lab for help

7 Confidentiality Statement (1 of 3) I understand that in the course of the Medical Assisting Program I will encounter information that is of a sensitive and personal nature. I acknowledge that information shared in the classroom environment and in the observation of clinical activities must be kept confidential and private. In the classroom, students are encouraged to participate openly, and as such may choose to disclose personal information. I understand the shared information is to be treated respectfully and with regard to its sensitive nature. I understand that I may not discuss any personal information about any student with anyone in or outside of the classroom, in any format or fashion. During the clinical practicum portion of my program, I will be involved in various aspects of patient care. I acknowledge that I may be allowed access to information that must not be shared or discussed with anyone other than the patients medical providers, and only if this information is necessary for quality healthcare services for that patient. I further agree to comply with any additional confidentiality procedures and/or stipulations that my specific clinical site may require of me. In accordance with current federal and state mandates designed to develop security standards to prevent unauthorized use of disclosure of any health information that is electronically maintained or used in electronic transmission, I also acknowledge that any access I have to written or electronic medical charting is strictly confidential. I further acknowledge that should I have access to such record maintenance systems, I will not attempt to review confidential material in any regard other than by direct order from a supervisor, physician, or healthcare provider. Additionally, I acknowledge that I must comply with any confidentiality and regulatory compliance standards that may be imposed upon me during any of my clinical activities. I acknowledge that should I break this statement of confidentiality, I may face consequences that may prevent me from completing this program, or other consequences yet to be determined. Student Name (printed): Signature: Date: 7

8 Background Check Release of Information (2 of 3) In order to practice as a medical assisting student in clinical agencies, it is necessary according to the Child/Adult Abuse Information Act (RCW through RCW ) to complete a criminal history background inquiry. Because of this statute, you are required to obtain your own Criminal History Background record from certifiedbackground.com, provide a copy of the record to the Peninsula College Medical Assisting Program Director, and authorize the Program and College to transmit that record or copy to the appropriate clinical agency, as necessary. The certifiedbackground.com inquiry will show any felony or misdemeanor charges for which you have been convicted. If any of these are present, you may not be allowed to perform the duties required of you in a clinical situation. If this is the case, you will not be able to successfully complete the practicum required in this program. In addition to this background check, the clinical agency hosting you for practicum may conduct an additional background inquiry directly, and the clinical agency may refuse placement of a student who does not provide the requested records or who has a record of prior criminal conduct. In compliance with the Medical Assisting Program s policy, I agree to obtain my criminal history background record from certifiedbackground.com. I hereby grant Peninsula College permission to keep a copy of my background check and I authorize the Medical Assisting Program to release a copy of this report to appropriate clinical agencies. I also understand that healthcare providers and clinical agencies may refuse placement of any student who has a record of prior criminal conduct. I understand that criminal background checks may produce inaccurate results because criminal records may lack unique information, the age of the conviction, or because of misspellings, clerical errors, or inaccurate identification information provide. I hereby agree to provide documentation of any known convictions that are not present on the criminal background check results, even if said conviction is for a misdemeanor offense. Student Name (printed): Signature: Date: 8

9 Informed Consent for Invasive/Noninvasive Procedures (3 of 3) In certain Medical Assisting courses at Peninsula College, students will have the opportunity to practice specific invasive and noninvasive clinical procedures on consenting Medical Assisting students. The invasive procedures that may be practiced on consenting Medical Assisting students are limited to intramuscular, subcutaneous, and intradermal injections and capillary and venous puncture for blood draws. Noninvasive procedures include EKGs, spirometry, ear lavages, eye irrigations, and ear and eye instillations with normal saline or sterile water, throat swabbing, and urine testing. Students will not perform, or allow to be performed, any invasive or any noninvasive procedures unless a faculty member or lab preceptor of the Medical Assisting program is present and directly supervising the performance of said procedures. Receiving injections, venipuncture, and capillary punctures by other Medical Assisting students is strictly voluntary. Students need to be informed of the risks of these procedures, which include, but are not limited to, the following: 1) Hematomas 2) Discomfort and/or pain 3) Infection 4) Damage to tissue and/or nerves 5) Complications of pregnancy 6) Blood exposure 7) Urine exposure 8) Saliva/sputum exposure This signed consent form must be completed prior to receiving or performing any invasive or noninvasive procedure, excluding vital signs, and covers every course that involves invasive and noninvasive procedures. Consent forms are kept in the student s confidential file in the Program Director s office. If a student wishes to revoke or decline their consent at any time, they must sign and submit a revocation/declination form to be kept in their confidential file. I acknowledge that in clinical courses I may be involved in procedures, both invasive and noninvasive, that may be hazardous to my health. I realize that in clinical classes I will be giving samples and testing body fluids. I realize that both students and faculty will practice OSHA and CDC standards and protect my safety within human limitations. I agree to participate in all competency procedures. I will inform my instructor immediately if I wish to revoke my consent. Student Name (printed): Signature: Date: 9

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