Use Internet Explorer as your browser to access the site. The online Clinical Site Placement Request form may be accessed at the following URL: http://sonce1.nursing.sunysb.edu/sclinreq.nsf The following is the initial screen you will see upon accessing the above URL. BEFORE FILLING OUT THE CLINICAL REQUEST FORM, CLICK ON THE AGENCIES BUTTON to View the list of Agencies with whom the School of Nursing has contract/affiliation agreements, and other previously used sites that did not require a contract/affiliation agreement. The following screen will appear: 1
Select a country from the drop down list made available to you by clicking on the arrow. After selecting a country the screen will refresh. You may now select a State/Province from the Drop-down list by clicking on the arrow. Selecting a State/Province will cause the screen to refresh again. Select a City from the drop-down list, by clicking on the arrow. You now have 2 Options to identify a clinical site: A. After selecting a city, a list of agencies (sites) and their addresses will appear. 1. Select one of these sites for your clinical placement. These are the sites with which we have contract/affiliation agreements, and other previously used sites that did not require a contract/affiliation agreement. 2. Contact the site to verify they are willing to accept you and that a preceptor will be identified. B. If you want to use a new site or one with which the School Of Nursing does not have an existing contract/affiliation agreement: 1. Contact the agency and get the correct name and title of the person who is responsible for clinical placements and find out if a contract/affiliation agreement is needed. 2. If a contract is needed, get the correct name and title of the person responsible for contract negotiations. 3. Get correct mailing address (be sure to include zip code). 4. This information will need to be entered in the Agency Information Section when you begin to fill out the Clinical Request Form. (Refer to the instructions on page 6) Once you have all the agency information, click the button. Follow the instructions for filling out each section of the Clinical Placement Request form. Click on the button. This will bring up the form that you need to fill out completely before you submit your electronic application Request for Clinical Site Placement. 2
The following screenshots have been broken down by section for ease of understanding. Please note: Required fields are indicated by a little yellow ball on screen. This form is electronically validated before submission. Please complete all required fields indicated as above. If you leave a required field blank, your request will NOT be submitted. You will receive an error message as follows: The first section to be filled out is Course Information: Make selections by clicking the box with the down arrow to the right of each field. Select the Program you are Enrolled in from the drop-down list: Select the Course Number from the drop-down list: 3
Note: Course numbers are not made available to choose from UNTIL a program name has first been selected Course Title is automatically filled in after selecting a course number: eg. Select Semester Start Date (first list), then select the Year from the second drop-down list: Choose your assigned Faculty from the drop down list: Note: The name of your Faculty will be assigned to you at orientation. This will be the person to select to submit your Clinical Placement Request to. For Method of Instruction, choose Distance Education if you are a DE student. If not, choose On-Site. 4
The next section you will need to complete is the Student Information section. Enter your First Name, Last Name, Street Address, City, State, Zip/Postal Code and Country in the fields provided. Enter the University Issued Student ID in the student ID field. Enter your Home Phone Number, Work Phone Number, Cell Phone and your Email address (if you have one) in the appropriate fields. Once again, required fields are marked with the next to them. Emergency Contact Information In the Emergency Contact information section, enter First Name, Last Name, Address and Phone Numbers of the person you wish the school to contact in an emergency. Please note the First Name, Last Name and Phone Number are required. 5
Agency Information Complete the Agency Information Section based on your preliminary research and information obtained when you clicked on the Agency button (Refer to page 2 instructions). If you selected Option B, select NEW as your agency choice. This is when you will have to type in the information for a site not on our list. If you selected Option A, DO NOT modify the Agency Choice field. Select from the drop down list Country, State and City. A list of agency sites will be displayed. Select an Agency. The address and special instructions for that agency (if any) will automatically be filled in. See the following screenshot example: Once again, required fields are marked with the next to them. Please note, for the Site Accreditation field you need to check all accrediting bodies that apply to the institution. Below is a list of the acronyms used. Joint Commission (formal JCAHO) DOH Department of Health ACME Accreditation Commission for Midwifery Education OASIS Office of Alcoholism and Substance Abuse Services NACHRI National Association of Children s Hospitals and Releated Insitutions NYSOMH New York State Office of Mental Health 6
Enter the Contact Information (Name, Phone and Title). Enter the Total # Clinical Hours planned for this site. This number is subject to approval by your Primary or designated faculty to whom you will be submitting the request. To enter the Start and End Date at Site: First make sure the start and end dates stated here under Agency Information are within the semester start date you entered under Course Information. If you are using Internet Explorer, click on the field and a calendar will come up. Select the date using the calendar. If you are using Netscape, enter the date in mm/dd/yy format eg. 01/02/2002. Preceptor Information If you already have an identified preceptor fill in all the information requested. Make sure to select all credentials that apply to your preceptor. Select area of practice for this clinical rotation. If the preceptor is to be assigned at a later date, type in TBA under first name. DO NOT LEAVE BLANK! Authorization Section If you selected Option B for a New Agency in the agency section, this field automatically defaults to Yes. If the agency you contacted does not require a contract, click on No. If you selected Option A for an Agency in the drop down list, this field automatically defaults to No. After completing all sections, click the Submit Button. WARNING Do not click the submit button more than once. Next you will see a screen that looks like the following: 7
This is your confirmation that your request has been received and routed to the faculty you chose. COPY DOWN THE TRACKING NUMBER EXACTLY AS IT APPEARS. Keep in a safe place. Print a copy of this page by clicking on the button Print This Page. You can get a status update of your request at any time by clicking on the View Status button. ENTER your Tracking Number EXACTLY AS PROVIDED TO YOU AFTER YOU SUBMITTED YOUR REQUEST. See the following screen: After entering the number: Click the Search Button to see a screen displaying the status of a request. 8
The following screen shows what a status screen might look like after faculty has approved a request and forwarded it on to Clinical Placement Office. The Clinical Placement Office verifies that a contract with the agency already exists. If a contract is needed the request gets routed to the Contracts Coordinator. If a contract is not needed the request is forwarded to the Staff Assistant for Clinical Placements for processing. Here is what the screen may look like when you click on View Status after it has been approved by the Clinical Placement Office. 9
After the Staff Assistant for Clinical Placements receives the request, a letter with supporting documentation is sent to the site and preceptor requesting the placement. When acceptance from site/preceptor is received, information will be entered into computer. When you click on the button VIEW STATUS the screen will look like the Sample Screen below: 10