CHECKLIST FOR ADMISSION REQUIREMENTS Medical Assisting & Allied Health Programs

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1 CHECKLIST FOR ADMISSION REQUIREMENTS Medical Assisting & Allied Health Programs You may use this checklist for your convenience to ensure that all items are completed. 1. Apply to Southern State Community College. This process must be completed before applying to the Medical Assisting (MAST) and/or Allied Health (ALTH) programs. Review Admission criteria in the college catalog at Paper applications are available in the Admissions office or online at College admission does not guarantee program acceptance. 2. Submit an official high school transcript or copy of GED certificate to the Admissions Office at the time of application. If you have transferable college credit, request that your official transcripts from previous college(s) be sent to Southern State Community College for transfer approval, Attention of Admissions Office, 100 Hobart Drive, Hillsboro, Ohio Transcripts are considered official only when they are mailed directly from the school to the College and bear the school seal or the signature of a school official. 3. If you do not have transferable college credit in mathematics and/or English Composition, take Southern State Community College s Accuplacer assessment. Scores should indicate you are ready for ENGL 1101 and MATH Dates for placement testing are available at Needed foundational courses, if any, resulting from Placement Test Scores must be completed prior to program acceptance. 4. Apply to the Medical Assisting (MAST)/Allied Health (ALTH) program by completing the printed MAST/ALTH application. A complete application packet must include the following documents: Signed Student Responsibilities Agreement The completed Application (front and back) Printed copy of your SSCC Course History including previously received transcript information or the SSCC AccuPlacer Assessment scores (indicating readiness for entry level ENGL 1101, MATH 1117). 5. ATTENTION APPLICATION SUBMISSION GUIDELINE: Schedule an appointment with the program director at Central Campus, Room 182, Hillsboro, Ohio ( rdavis@sscc.edu for appointment). To be considered for entry into the Medical Assisting/Allied Health Program, the required MAST/ALTH Application and required documentation must be HAND DELIVERED in one complete packet to the MAST/ALTH office, room #182, at Central Campus, Hillsboro, Ohio before the appropriate deadline. Applications submitted incorrectly (sent by , put in mailboxes, slid under the door, etc.) will not be accepted for consideration. Incomplete and/or late applications will not be considered. It is the responsibility of the applicant to be sure the required information has been submitted to the Medical Assisting/Allied Health office. It is strongly recommended that you make a copy of all documents for your personal records. 1

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3 READ ALL INFORMATION FOR APPLICANTS Program Admission It is strongly recommended to complete admission and program requirements early. Admission will be granted on a first-come, first-serve basis due to the limited availability of clinical sites for the clinical/practicum courses. Clinical/practicum placement is assigned by the course instructor and conditional upon site availability. Unanticipated loss of clinical/practicum placement may result in delayed clinical/practicum and graduation. Once accepted into the program, you must meet with an academic advisor to plan course selection. Criminal Background Checks Completion of a clinical/practicum is a required component of the Medical Assisting and Allied Health programs. Most, if not all, of the sites the College partners with to provide clinical/practicum experiences for students in the Medical Assisting and Allied Health programs now require that students submit to a criminal background check before a student will be permitted to begin the clinical/practicum experience at the site. Background checks include BCI and FBI screens. The cost of the criminal background check is included in the cost of the lab fee(s) that students are required to pay. Determinations for practicum participation cannot be made until BCI/FBI results are received. Delayed BCI/FBI results will prevent attendance at clinical/practicum sites until the next term offered. Students are required to self-disclose ANY criminal background at the time of initial application with a Medical Assisting/Allied Health faculty/staff representative. Students are to remain free of disqualifying convictions during program enrollment. Students are required to notify the Program Director or Dean of Technical and Career Education within one week of conviction occurring during acceptance/enrollment. Students who refuse to complete a background check required by a clinical/practicum site may be denied participation in a clinical/practicum experience by the site. Additionally, students with any criminal background may be ineligible for placement at a clinical/practicum site. Further, potential employers of SSCC Medical Assisting/Allied Health graduates may require criminal background checks as a condition of employment. Placement decisions are at the discretion of the clinical site and SSCC cannot guarantee placement. Please note that successful completion of a degree from Southern State Community College s Medical Assisting and/or Allied Health program(s) does not guarantee that a student will be able to obtain licensure/certification from any applicable professional licensing/certification entities and/or that a student will obtain employment in the Medical Assisting and/or Allied Health field(s). Students with certain criminal conviction(s) may, as a result of their criminal conviction(s), be unable to obtain/barred from obtaining professional licensure/certification in the Medical Assisting and/or Allied Health field(s). Students with specific questions regarding their ability to obtain professional licensure/certification should consult with their legal counsel. Further, students with certain criminal conviction(s) may, as a result of their criminal conviction(s), be unable to obtain/barred from obtaining employment in the Medical Assisting and/or Allied Health field(s). Students with specific questions regarding their ability to obtain employment should consult with their legal counsel. 3

4 Drug Screening Most, if not all, of the sites the College partners with to provide clinical/practicum experiences for students in the Medical Assisting and Allied Health programs now require that students submit to a drug screening before the student will be permitted to begin the clinical/practicum experience at the site. Students are responsible to pay for the cost of any required drug screening. In addition to a preadmission screening, the clinical sites may have policies in place under which the site reserves the right to conduct random drug screenings and/or to require students to submit to additional screenings over the course of the student s placement at the clinical site. Students who refuse to submit to a drug screening required by a clinical/practicum site may be denied participation in a clinical/practicum experience by the site. Additionally, students who fail a drug screening (i.e., have a positive drug screening) may be ineligible for placement at a clinical/practicum site. Students who fail a drug screening (i.e., have a positive drug screening) may also be subject to disciplinary action by the College under the College s Student Code of Conduct. Physical Examination Most, if not all, of the sites the College partners with to provide clinical/practicum experiences for students in the Medical Assisting and Allied Health programs require that students submit to a physical examination before the student will be permitted to begin the clinical/practicum experience at the site. The Physical Exam results must be presented to the clinical/practicum site on the SSCC physical form dated within the previous 12 months. Students who do not submit to a physical and/or do not submit the required documentation may be denied participation in a clinical/practicum experience by the site. The physical includes a rubella titer, rubeola titer, mumps titer, varicella titer, a first year 2-step TB and an annual TB skin test each subsequent year. Students will also be required to provide documentation of a onetime adult Tetanus/ Diptheria/ Pertussis booster. Student must remain current on tetanus/diphtheria booster (one every 10 years). In addition, each student is required to complete a hepatitis B immunization series (must have documentation of first injection to start clinical) if they have not previously received it. The student must submit the following documentation to the MAST/ALTH office: Physical form that must be signed by both physician and student Documentation verifying vaccination or diagnostic screening results and TB Testing Record Immunization history All documents, once submitted, will be maintained by (and become the property of) the program. The clinical/practicum site may also require that students meet the same requirements as the employees of the clinical/practicum site. These additional requirements may include, but are not limited to the following: Criminal background checks Random drug testing HIV testing if potentially exposed to blood borne pathogen; It is recommended that students receive flu vaccinations; some sites require this vaccine prior to site attendance. Individuals choosing not to obtain a flu vaccine may be ineligible for clinical/practicum sites requiring flu vaccinations unless otherwise stipulated per site. 4

5 Responsibility for Treatment The student enrolled in a clinical/practicum experience will assume the cost of treatment or care for any injury or medical condition incurred during the course. Health Insurance Most, if not all, of the sites the College partners with to provide clinical/practicum experiences for students in the Medical Assisting and Allied Health programs require that students provide proof of personal health insurance prior to attending their clinical/practicum courses. Liability Insurance Students are required to obtain professional liability insurance through the SSCC Bookstore prior to attending their clinical/practicum courses. This insurance is in effect for one year from the date of purchase and may need to be renewed for second year/last term courses. Clinical/Practicum The student enrolled in a clinical/practicum experience will receive a copy of the Practicum Guidelines with their packet of information at clinical/practicum orientation. This contract outlines the responsibilities of the student during the clinical/practicum experience. The required Background Check, Clinical/Practicum ID Badge, Physical Exam, GPA for Career, GPA for immediate past term, and Health/Liability Insurance will be completed/collected during the mandatory clinical/practicum orientation. Conferences Student-faculty conferences will be scheduled by appointment at the faculty s discretion and as needed by the student. MENTAL AND PHYSICAL QUALIFICATIONS REQUIRED OF APPLICANTS TO MEDICAL ASSISTING/ALLIED HEALTH PROGRAMS In order to be eligible to participate in the clinical/practicum course requirement, the clinical/practicum site may expect students in the Medical Assisting Program to meet certain minimum acceptable mental and physical qualifications. Additionally, in order to obtain employment as a professional medical assistant, students who successfully complete/earn a degree from the Medical Assisting program may be expected to meet certain minimum acceptable mental and physical qualifications. These qualifications may include, but may not be limited to the following: 1. Identify cause-effect relationships in clinical situations; research and analyze data to aid in problem-solving; read and comprehend text, numbers and graphs displayed in print and on a video monitor; 2. Frequently sit for extended periods and/or work in a standing position and walk frequently. 3. Lift and transfer patients up to six inches from a stooped position, then push or pull the patient s weight up to three feet. 4. Lift and transfer patients from a stooped to an upright position to accomplish exam table-to-chair and chair-to-exam table. 5

6 5. Physically apply up to ten pounds of pressure to bleeding sites, or in performing CPR. 6. Respond and react immediately to verbal instructions/requests and to auditory signals from monitoring equipment; perform auditory auscultation without impediment. 7. Physically perform up to a twelve-hour shift clinical laboratory experience. 8. Observe specimen and reaction colors and turbidity and observe patient responses. 9. Make fine adjustments to hand-held objects, handle contaminated needles safely and move instruments weighing up to twenty pounds from one area to another. 10. Visual activities both physically close and distance involving objects, persons, and paperwork, as well as discriminate depth and color perception. 11. Discriminate between sharp/dull and hot/cold when using both hands. 12. Perform mathematical calculations for medication preparation and administration. 13. Attention to detail; sustain concentration to a task over an extended period of time. 14. Read and comprehend clinical textbooks, procedures, numbers and graphs. 15. Communicate effectively, both orally and in writing, using appropriate grammar, vocabulary, word usage, and interpersonal skills. In order to be eligible to participate in the clinical/practicum course requirement, the clinical/practicum site may expect students in the Phlebotomy program to meet certain minimum acceptable mental and physical qualifications. Additionally, in order to obtain employment as a professional phlebotomist, students who successfully complete/earn a degree from the Phlebotomy program may be expected to meet certain minimum acceptable mental and physical qualifications. These qualifications may include, but may not be limited to the following: 1. Identify cause-effect relationships in clinical situations; research and analyze data to aid in problem-solving; read and comprehend text, numbers and graphs displayed in print and on a video monitor; 2. Read and comprehend clinical textbooks, procedures, numbers and graphs; 3. Communicate clearly and effectively verbally and in writing with patients, physicians, and other health care professionals; 4. Move from room to room and maneuver in small spaces; 5. Stand and walk for extensive periods of time; 6. Make fine adjustments to hand-held objects, handle contaminated needles safely and move instruments weighing up to twenty pounds from one area to another; 7. Hear and understand patients, physicians, and other health care providers; hear a variety of equipment alarms and sounds; 6

7 8. Observe specimen and reaction colors and turbidity and observe patient responses. In order to be eligible to participate in the clinical/practicum course requirement, the clinical/practicum site may expect students in the Pharmacy Technician program to meet certain minimum acceptable mental and physical qualifications. Additionally, in order to obtain employment as a professional pharmacy technician, students who successfully complete/earn a degree from the Pharmacy Technician program may be expected to meet certain minimum acceptable mental and physical qualifications. These qualifications may include, but may not be limited to the following: 1. Perform mathematical calculations for medication preparation and administration; 2. Communicate effectively, both orally and in writing, using appropriate grammar, vocabulary, word usage, and interpersonal skills; 3. Hear and understand patients, physicians, and other health care providers; hear a variety of equipment alarms and sounds; 4. Frequently work in a standing position and walk frequently; 5. Read and comprehend clinical textbooks, procedures, numbers and graphs; 6. Attention to detail; sustain concentration to a task over an extended period of time. In order to be eligible to participate in the clinical/practicum course requirement, the clinical/practicum site may expect students in the Medical Billing and Coding program to meet certain minimum acceptable mental and physical qualifications. Additionally, in order to obtain employment as a professional coder, students who successfully complete/earn a degree from the Medical Billing and Coding program may be expected to meet certain minimum acceptable mental and physical qualifications. These qualifications may include, but may not be limited to the following: 1. Perform mathematical calculations for medication preparation and administration; 2. Communicate effectively, both orally and in writing, using appropriate grammar, vocabulary, word usage, and interpersonal skills; 3. Attention to detail; sustain concentration to a task over an extended period of time; 4. Read and comprehend clinical textbooks, procedures, numbers and graphs; 5. Familiarity with medical terminology. In order to be eligible to participate in the clinical/practicum course requirement, the clinical/practicum site may expect students in the Medical Transcription program to meet certain minimum acceptable mental and physical qualifications. Additionally, in order to obtain employment as a professional transcriptionist, students who successfully complete/earn a degree from the Medical Transcription program may be expected to meet certain minimum acceptable mental and physical qualifications. These qualifications may include, but may not be limited to the following: 1. Communicate effectively, both orally and in writing, using appropriate grammar, vocabulary, word usage, and interpersonal skills; 7

8 2. Attention to detail; sustain concentration to a task over an extended period of time; 3. Follow/comprehend voice commands; 4. Hear and understand physicians and other health care professionals; 5. Familiarity with medical terminology; 6. Knowledge of diseases and medical conditions and corresponding treatments and medications. Students who apply to the Medical Assisting and/or Allied Health program(s) are responsible for determining their own eligibility in light of these qualifications, for informing the College of any potential problem areas and for notifying the Medical Assisting/Allied Health Department of any particular accommodations they may need. Students with disabilities are encouraged to contact the Office of Disability Services to determine appropriate accommodations. The College does not discriminate on the basis of disability in admission or access to its programs, services, or activities for qualified individuals who meet essential eligibility requirements. Students with disabilities who enter the program do so with the understanding that they will be expected to meet course requirements with or without any REASONABLE accommodation that may be provided by the College. 8

9 THIS PAGE IS FOR YOUR REFERENCE ONLY AND DOES NOT NEED COMPLETED AT THIS TIME NOR RETURNED WITH THE APPLICATION PACK Eligibility for Clinical Placement Information Southern State Health Sciences students are assigned care of older adults and children throughout their practicum/ clinical experience. Therefore, all students enrolled in a Health Sciences program will have a criminal background record check run. In order to assist you and the Division in determining the potential impact of this background check, please complete the following. (Note: * = Absolute Bar) Homicide* Murder* Voluntary Manslaughter* Involuntary Manslaughter Felonious Assault Aggravated Assault Assault Failing to Provide for a Functionally Impaired Person Aggravated Menacing Patient Abuse; Neglect* Kidnapping Abduction Child Stealing Criminal Child Enticement Extortion Coercion Rape* Sexual battery* Corruption of a Minor Gross Sexual Imposition* Sexual Imposition Importuning Voyeurism Public Indecency Felonious Sexual Penetration* Compelling Prostitution Promoting Prostitution Procuring Prostitution Disseminating Matter Harmful to Juveniles Pandering Obscenity Pandering Obscenity Involving a Minor* Pandering Sexually Oriented Matter Involving a Minor* Illegal Use of Minor in Nudity Oriented Material* Aggravated Arson Aggravated Robbery Robbery Aggravated Burglary Burglary Breaking and Entering Theft; Aggravated Theft Unauthorized Use of a Vehicle Unauthorized Use of Property Passing Bad Checks Misuse of Credit Checks Forgery Medicaid Fraud Securing Writings by Deception Insurance Fraud Receiving Stolen Property Unlawful Abortion Endangering Children Contributing to Unruliness or Delinquency Domestic Violence of a Child Prohibition of Conveyance of Certain Carrying Concealed Weapons Items onto Grounds of Detention Facility or Mental Health or MRDD Facility Having Weapon While Under Disability Improperly Discharging a Firearm Into Habitation Corrupting Another with Drugs Trafficking in Drugs Cultivating Marijuana Funding of Drug/Marijuana Trafficking Illegal Admin/Distrib of Anabolic Steroids Drug Abuse (not a minor drug possession offense) Permitting Drug Abuse Deception to Obtain Dangerous Drugs Illegal Processing of Drug Documents Adulteration of Food* Have you been convicted of, pled guilty to, had a judicial finding of guilt for, or had a judicial finding of eligibility for treatment and/or intervention in lieu of conviction for, or are you currently under indictment for any of the above offenses? (Circle one) YES NO I certify that the above information is correct and complete to the best of my knowledge and belief. I understand and agree that misrepresentation, falsification or omission of material fact may be cause for rejection of my application or for termination after acceptance into the program. I further understand that a Yes answer to the above question may result in me being ineligible for clinical placement and, therefore, completion of the program. 9

10 STUDENT RESPONSIBILITIES MEDICAL ASSISTING/ALLIED HEALTH PROGRAM I understand that if admitted to the Medical Assisting/Allied Health Program my student responsibilities will include: 1. Maintaining a minimum 2.4 immediate previous term and cumulative GPA to be eligible for practicum. Note: all courses in the MAST/ALTH curriculum must be completed with a B or better. 2. Gaining the required knowledge and skills to be competent for an entry-level position in my chosen health sciences career. 3. Traveling to and from a clinical site approximately miles away (depending on student residence) and arriving as early as 6 am and as late as 6 pm for some sites/departments. Clinical Practicum days and hours may vary and might include holidays and weekends. 4. Spending up to hours a week in the classroom, lab, and/or hospital setting. 5. Securing a reliable source of transportation to/from campus and clinical/practicum sites. 6. Caring for and working with diverse patient and peer populations of all ages, ethnic, and social backgrounds. 7. Maintaining patient and personal safety and confidentiality at all times. 8. Devoting approximately 12 hours a day to self-education, including reading, group study, lab time and clinical/administrative skill practice/preparation for competency examinations. 9. Developing a plan to address personal, work, and educational needs. 10. Following the timelines and guidelines/standards established by the course and/or program. 11. Seeking to be a professional; demonstrating a desire to continually improve and not expecting others to think and act as I do. 12. Obtaining and/or submitting documentation of completion of required vaccinations. 13. Keeping program officials updated with current telephone number, address, and Attending mandatory meetings, clinical/practicum orientations, and cooperating with SSCC representative performed BCI and FBI background checks, and required drugs screenings. 15. Purchasing clinical uniforms and required supplies. 10

11 PROGRAM AGREEMENT As an applicant to this program or student in this program, I acknowledge that I have read and understand the student responsibilities and essential qualifications. I acknowledge that I am capable of meeting the responsibilities and performing the abilities and skills outlined in this document with or without reasonable accommodation and understand that my status as a student in this program depends on my continued ability to successfully meet these responsibilities and demonstrate these abilities and skills. I understand that if I am no longer able to meet these responsibilities and essential qualifications I will immediately notify the program director. Applicant Printed Name Date Applicant Signature Date Clinical/Administrative Education Partners The Medical Assisting/Allied Health Program is affiliated with numerous medical centers, specialty clinics/offices, and pharmacies. Practicum/clinical sites are contacted and arranged by the Practicum Coordinator and/or the course instructor only; sites are not guaranteed. Students are not permitted to arrange, schedule, and/or make changes in practicum/clinical rotation. The contracted medical centers, specialty offices and pharmacies may be located in the following counties (subject to change; not inclusive): Adams, Brown, Clinton, Fayette, Highland, Pickaway, Pike, Ross and Scioto Counties Medical Assisting Students will be required to rotate through four clinical sites for a total of 244 hours during the program. Phlebotomy Technician Students will be required to rotate through one clinical site for a minimum of 120 hours and completion of the required successful venipunctures/capillary sticks during the program. Pharmacy Technician Students will be required to rotate through one clinical site for a minimum of 61 hours during the program. To be certain your application is received by MAST/ALTH office staff, hand delivery of the completed packet is required to avoid ineligibility due to possible delay in postal delivery and resultant missed deadlines. Deliver the completed forms to Southern State Community College, Medical Assisting/Allied Health Program (room #182), 100 Hobart Drive, Hillsboro, OH

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13 APPLICATION FOR MEDICAL ASSISTING & ALLIED HEALTH PROGRAMS Office use only Date received Initials Accuplacer Result Date: ENGL: MATH: TYPE OR PRINT IN BLUE OR BLACK INK ONLY. I am requesting to enter the identified program during the following quarter (mark only one): Medical Assisting Billing & Coding Certificate Pharmacy Technician Certificate Phlebotomy Certificate Transcription Certificate Fall Semester (verify campus offerings) - Year Spring Semester (verify campus offerings) - Year NOTE: This application is good only for the term and year marked above. Correspondence will be sent via the address indicated below (SSCC required once registered) Notify the MAST/ALTH Department of any changes after submission. It is your responsibility to ensure that all requested documents are received before the deadline date Name: Mr. Ms. Last First Middle (Other names used) Address Street City State/Zip Day Phone Evening Phone address(es) Print Legibly We are not responsible for illegible or incorrect addresses. A response may not be received by student. Notices will not be sent via postal service, you will receive notice only. Student SSCC ID# Date of Birth High School/GED Graduation date/ged date List any Colleges or Post-Secondary Schools Attended (regardless of relevance to health sciences field) 13

14 List any healthcare work experience Have you applied to any Health Sciences classes at Southern State previously? Yes No Have you attended any Health Sciences classes at Southern State previously? Yes No Have you tested or trained as a medical professional? Yes No Why do you believe you would be successful in this program? Applicant s Signature Date SSCC does not discriminate against applicants, employees, or students on the basis of race, color, creed, religion, age, sex, marital status, veteran status, national origin, ancestry, citizenship, gender identity, sexual orientation, or disability. Questions about this should be directed to the Title IX Coordinator, 100 Hobart Drive, Hillsboro, OH 45133; (937) Accommodations for persons with disabilities may be made through the Section 504 Coordinator, 100 Hobart Drive, Hillsboro, OH 45133; (937) Effective 5/1 14

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