Patient Care Technician Program

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1 Workforce and Continuing Education Division Patient Care Technician Program This program prepares a student to work as an entry-level patient care technician in a clinic, hospital, nursing home or long-term care facility. Students will learn to perform basic laboratory procedures and electrocardiograms, check vital signs, assist in medical examinations and how to perform, and gain experience in phlebotomy. This program is a combination of lecture and practical exercises in the medical laboratory. Upon successful completion of this program, the student is eligible to take the State of Texas Nurse's Aide Certification exam as well as the National Center for Competency Testing, NCCT, certification exams for EKG, Phlebotomy and Patient Care Technician Certification. Patient Care Technician Part One, Two or Three may be taken in any order however; course prerequisites must be completed prior to registration. The following are not included in the cost of the course and are the responsibility of the student: The State of Texas Nurse s Aide Certification exam; National Center for Competency Testing, NCCT Certification exams for EKG, Phlebotomy and Patient Care Technician; Criminal background check; Liability insurance, Uniform (royal blue); Watch with second hand and; Textbooks. IT ALL BEGINS HERE!

2 Patient Care Technician Program CHECK LIST All program prerequisites must be met before registering. Student Checklist Patient Care Technician, Part One (Phlebotomy Technician) High School Diploma or equivalent. Brookhaven College- Immunization Record must be completed and signed by Brookhaven College Health Center (Immunizations must be current; must have had three doses of Hepatitis B Vaccine; and TB test). Dallas County Community College District, Continuing/Workforce Education Registration Form. Patient Care Technician, Part Two (EKG Technician Certification) High School Diploma or equivalent. Dallas County Community College District, Continuing/Workforce Education Registration Form. Patient Care Technician, Part Three (Nurse Aid Certification) High School Diploma or equivalent. Brookhaven College- Immunization Record must be completed and signed by Brookhaven College Health Center (Immunizations must be current; must have had three doses of Hepatitis B Vaccine; and TB test). Nurse Aide Registry (NAR) Form Completed and signed. Ability to lift 50 lbs. Current Basic Cardiac Life Support, BCLS, for Health Care Providers card (within 2 years). Criminal Background check. Issued by instructor. Dallas County Community College District, Continuing/Workforce Education Registration Form.

3 Patient Care Technician Program Your registration packet includes the following: 1. Patient Care Technician Program Cover Sheet 2. Brookhaven College- Immunization Record Bring to the Brookhaven College Health Center Nurse for verification of immunizations. This form must be submitted to the Workforce and Continuing Education Division Office prior to registration. Please allow enough time to complete all three doses of the Hepatitis B Vaccine prior to registering for Patient Care Technician, Part One or Part Three. 3. Dallas County Community College District, Continuing/Workforce Education Registration Form A registration form has been provided for your convenience. For additional copies go to; Continuing Education Registration Form and to download additional copies. Please check with the Workforce and Continuing Education registration staff to make sure all course prerequisites have been met and all required forms have been submitted prior to registration. 4. Brookhaven College, Workforce and Continuing Education Nurse Aide Registry (NAR) Form- This form must be filled out prior to registering for Patient Care Technician, Part Three. 5. A student checklist Has been provided to help you keep track of the program requirements. Use this checklist to make sure you have met all prerequisites before registration. Helpful Information Please visit our health center for a list of shots they can assist you with. THE BHC HEALTH CLINIC CAN GIVE EITHER HEPATITIS SERIES. The most common series requires up to 6 months to complete however, the TWINRIX series can be completed within 21 days. TITER tests can be taken to confirm required immunizations. The Health Center is located in the Student Services Center, Building S, Room S072. Liability Insurance MUST be paid at the time of registration. Social Security Card Please note: You will be required to present your social security card at the time you take the State of Texas Nurse s Aide Certification Exam as well as the National Center for Competency Testing, NCCT, Certification exams for EKG, Phlebotomy and Patient Care Technician. These exams are not provided by Brookhaven College, Workforce and Continuing Education Division. For additional information about the nearest test site contact NCCT at,

4 BROOKHAVEN COLLEGE WORKFORCE AND CONTINUING EDUCATION NURSE AIDE REGISTRY (NAR) All applicants must be checked for listing on the Nurse Aide Registry, NAR, prior to admission. Pursuant to 42 code of Federal Regulation (CFR) (1)(ii), nurse aides with a finding of abuse, neglect, or misappropriation of resident s property are prohibited from employment in nursing and skilled nursing facilities. In addition 42 CFR (c)(4)(d) mandates that all findings of abuse, neglect, or misappropriation of resident s property remain on the registry permanently. In order to determine if an individual is listed on the Nurse Aide Registry as UNEMPLOYABLE due to abuse, neglect or misappropriation of resident s property, please call the departments toll-free voice information system at To Be Filled Out By Applicant: Full Name Social Security Number - - Have you ever been certified as a Nurse Aide in Texas? If yes, when? What name was on the certificate? I certify that the information provided in the above application is true and correct. I understand that false information on this application may result in immediate suspension or removal from the course with no refund. Signature of Applicant Date ************************************* To Be Filled Out By Sponsored Agency Representative or Training Program Representative if Applicant has no Sponsor. Nurse Aide Registry checked? Yes No Results: Signature of Representative / Date

5 Continuing/Workforce Education Registration Educational opportunities are offered by the Dallas County Community College District without regard to race, color, age, national origin, religion, sex, disability or sexual orientation. Please check the college you plan to attend. Brookhaven College Cedar Valley College Eastfield College El Centro College (ECC) 3939 Valley View Lane 3030 North Dallas Avenue 3737 Motley Drive Main & Lamar Streets Farmers Branch, TX Lancaster, TX Mesquite, TX Dallas, TX fax fax fax Mountain View College North Lake College Richland College ECC-Bill J. Priest Campus 4849 West Illinois Avenue 5001 N. MacArthur Blvd Abrams Road 1402 Corinth Street Dallas, TX Irving, TX Dallas, TX Dallas, TX fax fax fax fax Dallas TeleCollege 9596 Walnut Street Dallas, TX fax Student Information Please print. * Please check appropriate box; your responses to these questions are voluntary - information is used to meet Texas State reporting requirements only. New Student * Male *Social Security Number: - - Existing Student * Female DCCCD Student I.D. Number: Ethnicity information is used to meet Texas State reporting requirements and providing this information is voluntary on your part. White, Non-Hispanic Hispanic American Indian/Alaskan Native Other Black, Non-Hispanic Asian/Pacific Islander International/Non-Immigrant No Response Last Name First Name MI Address City State Zip County Country Home Phone Work Phone Cell Phone Fax Address Date of Birth I verify that the above information is accurate. Signature Date Course Information (Certain Continuing Education courses have entrance requirements that student must meet prior to registration. Consult college for details.) REG # TERM COURSE # SECTION # COURSE TITLE DAYS DATES TIME LOCATION FEE Payment Information You are able to pay by credit card on the web if you have previously registered and provided your address. If paying by check, include Driver s License Number and State on the top of the check, not on this form. Refund Policy: A refund of 100 percent will be made if requested prior to the first scheduled meeting day. Your request for a refund must be made during business hours prior to the first day of class to qualify for a 100 percent refund. A refund of 80 percent is allowed before the close of business on the day of the second class meeting. No refund is allowed after the second class meeting. Should the college cancel the class a 100 percent refund will be issued. Refunds may take up to four weeks to process. The Colleges of the Dallas County Community College District reserve the right to make changes that may include, but are not limited to, the days and times courses are offered, classroom location, instructors who teach the course, and cancellation of courses. Third Attempt to Enroll in a Course: Effective for Fall Semester 2005, the Dallas County Community Colleges will charge a higher tuition rate to students registering the third or subsequent time for a course. All third and subsequent attempts of the majority of credit and Continuing Education/Workforce Training courses will result in higher tuition to be charged. Developmental Studies and some other courses will not be charged a higher tuition rate. Third attempts include courses taken at any of the Dallas County Community Colleges since the Fall 2002 semester. FORM NO /06

6 Brookhaven College Immunization Record Workforce and Continuing Education Division Last Name First Name Middle Initial Date of Birth Sex: M F Student ID# *Please have the Brookhaven College Health Center Nurse initial form. MEASLES (Rubeola) HEPATITIS B Select option 1 or 2 and provide requested documentation. 1. Dates of immunization: Two (2) are required. A. First immunization with live attenuated virus. (Given after 1957 and given on or after student s first birthday.) B. Second immunization with live attenuated virus. (Given at least 30 days after first immunization.) Date of blood titer. (Must attach a copy of laboratory test in English.) 2. Date of immunization: / / ( )* / / ( )* OR Dates of immunization (Completion of three dose series required series MUST be completed prior to registration.) 1. Date of immunization: / / ( )* 2. Date of immunization: / / ( )* 3. Date of immunization : / / ( )* 1. Date of test: / / ( )* MUMPS Select option 1 or 2 and provide requested documentation. 1. Dates of immunization: Two (2) are required. a. First immunization with live attenuated virus. (Given after 1957 and given on or after student s first birthday.) 2. Date of blood titer. (Must attach a copy of laboratory test in English.) 1. Date of immunization: / / ( )*OR VARICELLA 1. History of disease: ( )* 2. Two (2) doses (4 weeks apart) / / ( )* / / ( )* 2. Date of test: / / ( )* RUBELLA (German Measles) Select option 1 or 2 and provide requested documentation. 1. First immunization with live attenuated virus. (Given after 1957 and given on or after student s first birthday.) 2. Date of blood titer. (Must attach a copy of laboratory test in English.) 1. Date of immunization: / / ( )* OR Td or Tdap/Tetanus, Diphtheria and Acellular Pertussis Date of most recent tetanus booster. (Within 10 years for All students.) 1. Date of immunization: / / ( )* 2. Date of test: / / ( )* MMR 1. Date of immunization: / / ( )* 2. Date of immunization: / / ( )* TB PPD Date: / / ( )* Result: Negative Positive mm. ( )* Chest X Ray: Negative Positive Brookhaven College Health Center Nurse Signature SIGNATURE: DATE:

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