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Glendale Union High School District Health Careers Education Program Clinical Requirements Checklist 2019-2020Student Information SheetProof of Legal Presence (Copy of your Arizona Driver’s License or Arizona State-Issued Identification Card). Comprehensive list of acceptable documents is listed on the AZ State Board of Nursing Website. However, an Arizona State Driver’s License or Arizona State-issued ID card is required for board exams.Copy of Social Security cardCopy of your Health Insurance card or letter stating that you do not have health insurance.Copy of your American Heart Association Basic Life Support for Healthcare Provider Card (Cost - $40.00 cash or check made payable to HOSA. Classes provided. Link to sign up for classes is on our website.)Copy of your Level 1 Fingerprint Clearance CardArizona Fingerprinting Services (Cost: $15.00 Cash Only)Mobile service will provide fingerprinting at Welcome Night and in classLevel 1 Fingerprint Clearance Card Application (Cost: $67.00 cash or check made payable to HOSA.)Negative drug screen results (Cost: $36.00 cash or check made payable to HOSA. Instructions will be given in class. Drug tests will not be given without an authorization form. Please do not go to the lab prior to instructions. Thank You!)SonicTest Labs – Phoenix Location2830 W. Glendale Ave Suite 17Phoenix, AZ 85051602-888-2351Physical examination with doctor’s clearance to participate in HCE program (See form provided) FREE SPORTS PHYSICAL offered at Sunnyslope High School on Saturday, March 30, 2019. Talk with your athletic department on your home campus for further details. Information also posted on our website.IMMUNIZATIONS:TB PPD/X-Ray – Tuberculin skin test within the past 12 months or documentation as a previous positive reactor or negative x-ray. (Approximately $65.00 for TB test and reading at CVS Minute Clinic)MMR - Proof of rubella and rubeola immunity by positive antibody titers OR 2 doses of MMRHep B - Evidence of the series of three Hepatitis B vaccinationsTdap – Must have been done within the last 10 yearsVaricella – Varicella immunity, by positive history of chicken poxs or proof of Varicella immunization.Flu Vaccination (ONLY during time required by hospital or healthcare facility. Further instructions will be given. Flu shots not required for Summer classes.)myClinical Exchange Account Access (Cost: $36.50 cash or check made payable to HOSA.)?Completion of all forms and necessary training required by hospital or healthcare facility. These will all be completed through your myClinical Exchange account. See complete list below:Student Parking and MapsExhibit A – Statement of ResponsibilityExhibit B – Statement of AccountabilityInformation, Privacy ,Security, and HIPAA Training ConsentTenet Ethics and Compliance Policies ConsentCorporate Compliance ModuleHIPAA ModuleInfection Control ModulePatient Safety ModuleProfessional Conduct ModuleProfessional Conduct Final AssessmentPatient Safety Final AssessmentInfection Control Final AssessmentCorporate Compliance Final AssessmentStudent Clinical Documentation Form (Evaluation to be completed after each clinical rotation throughout the class. This is ongoing throughout the year.)Clinical Competency Sheet (To be completed at the end of each semester.) ................
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