4 PN Documentation FAQ Page Questions? 1. Review your materials 2. Visit the Documentation FAQ page located at 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 with a list of questions. Please do not call.
5 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 (return by December 28, 4:00pm)
6 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! Mark name and entrance year
7 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 by December 28, 2015, 4:00 PM.
8 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 Complete and return the forms today.
9 What will happen if I miss the deadline? Failure to turn in your complete documentation packet by December 28, :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. Complete the above form and pass forward.
10 Documentation Release Form Allows release of information to clinical agencies. Immunization Status; Personal Health & Liability Insurance; CPR (Health Care Malpractice Insurance; Professional Level); 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. (instructions are included in your packet)
11 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 9 th, 8:00-12:00pm *We suggest you purchase two.
12 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 9. DSHS Background Authorization
13 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 Additional Checklist Items: CPR Card, Insurance (Health, Liability, Malpractice), Modules
14 Certified Background.com Ordering Instructions 1. Go to and click on "Students." 2. In the Package Code box, enter the package code: OL32PN Background Check + Annual Medical Document Manager $ Enter your payment information Visa, MasterCard, or Money Order. Follow the online instructions to complete your order.
15 Submitting Documents to Medical Document Manager Submit your documents to CertifiedBackground.com/Document Manager via: 1. Upload (similar to Facebook) Accepts JPG or PDF. 2. Fax (include fax sheet they provide) 3. Phone App (IPhone) *Recommended 4. Mail (include sheet they provide)
16 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 profile.
17 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 Health, Malpractice, and Liability Insurance Modules
18 **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). Failure to comply may result in missed clinical days and/or dismissal from the program.
19 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. 1 st step: Injection, return to read nd step: repeat injection, return to read, otherwise 1 step TST. (typically within one week of 1 st step completion, some providers prefer a month between injections) OR All TB Skin Tests results must cover the duration of the program (December December 2016).
20 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 attendance.
21 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 28 th. 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 Dean)
22 Hepatitis B Not immunized yet? Get your first immunization ASAP. Series must be complete by the end of spring quarter! Immunization Timeline: 1 st immunization ~ Early November 2 nd immunization ~ 1 month later (early December) 3 rd immunization ~ 6 months from the 1 st (early May) Titer ~ 6-8 weeks later (Mid-July)
23 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. Documented history of the diseases are not accepted, a titer is required to show immunity.
24 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 influenza vaccine to the new strain.
25 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 1 st year of the card is accepted only. Cards whose start dates are prior to December 2015 will not be accepted.
26 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, for any additional options for BLS classes, should they arise.
27 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. Submit Receipts to Certified Background
28 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. Recommended browsers: Firefox, Chrome or Internet Explorer. The modules will not work on tablets (of any kind) or phones. *Pop-up blocker must be disabled* 1) Type, 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.
29 Modules Example of Compliance module screenshot (keyboard command prtscrn and paste to a word document)
31 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 9. DSHS Background Authorization
32 DOCUMENTATION FORMS - 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. ALL information will be kept confidential
33 DOCUMENTATION FORMS PERMISSION TO USE STUDENT WORK & STUDENT MAILBOX CONSENT PERMISSION TO USE STUDENT WORK Used for accreditation purposes. STUDENT MAILBOX CONSENT Gives permission for faculty and staff to return assignments in your student mailbox.
34 DOCUMENTATION FORMS - 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 Complete Name and Date sections Required by Harrison Medical Center
35 DOCUMENTATION FORMS - 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. Return the form TODAY.
36 DOCUMENTATION FORMS - 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 UNKNOWN or a QUESTION MARK in the box. If you do, the form will be sent back.
37 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) You will also be required to turn in a copy of your Driver s License.
38 Further Questions?? ***** Due date Can you submit the documents prior to the deadline of December 28 th? Absolutely! We recommend getting started now on all documentation. Submit them as you get them.
39 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) 5. Modules
40 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 10. Harrison Packet with Picture ID attached
41 PN Documentation FAQ Page Questions? 1. Review your materials 2. Visit the Documentation FAQ page located at 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 with a list of questions. Please do not call.
42 Hints: Keep copies for your records. *Remember we do not make copies. Please do not register until your registration letter has arrived, you may inadvertently register for the incorrect item numbers. Submit everything in a single SHEET PROTECTOR.
43 Welcome to the Practical Nursing Program Olympic College Class of 2016!
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