College & Residency Program Coordinators

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Statewide Healthcare Alliance Summit
Tuesday, October 17, 2017
Chula Vista Resort - Wisconsin Dells

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Centers for Disease Control and Prevention "CDC is the nation's health protection agency, working 24/7 to protect America from health and safety threats, both foreign and domestic.  CDC increases the health security of our nation."

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STEP 1:  Complete the Clinical/Residency Placement Request Process
  1. You must have a current contract/affiliation agreement with the healthcare organization to proceed.  Please check with your school/residency program to confirm whether or not your school/residency program has a current affiliation agreement with the healthcare organization.
  2. Complete the clinical/residency program placement request form (see below).  This Excel form has two sheets; 1) Preceptor Requests, 2) Groups with Instructors.
  3. For preceptorships, requests should be submitted 10-12 weeks before the clinical start date.
  4. If you haven't heard back in a reasonable amount of time, please contact the facility representative directly.
  5. Email the completed form to the contact person listed on the "Contacts" link below.
  6. If approved, continue to Step 2.
  7. If denied, the facility will contact you.
STEP 2:  Complete the Clinical/Residency Program Placement Process (after you receive approval)
  1. Complete and submit the affiliation verification form (see below) to the clinical/rotation site.  Form is to be submitted on or by the clinical/residency program start date and no more than two weeks before the clinical/residency program start date.
  2. After all of the modules below are completed, maintain in the school files the signed/dated confidentiality agreement and acknowledgement of orientation modules (see below). (For Residents: Click the 'Residents' tab under the 'Clinicals/Rotations' dropdown menu for their learning modules and confidentiality agreement, etc.)
  3. Contact the clinical/rotation site to insure computer access and training.
STEP 3: Faculty should submit the student completed "Student Evaluation of the Clinical Site OR Precepted Clinical" forms to the healthcare facility's clinical site corrdinator no later than TWO WEEKS after completion of the clinical. (Resident coordinators see 'Residents' webpage for 'Evaluation of Rotation Site' form to be completed by residents.)
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The following orientation modules must be completed annually by faculty and students prior to working at a clinical site. Each module has a completion confirmation page that must be signed and submitted.  After you have completed all of the modules, the school will retain your signed and dated "Confidentiality Agreement and Acknowledgement of Orientation Learning Modules" form. (For Residents: Click the 'Residents' tab under the 'Clinicals/Rotations' dropdown menu for their learning modules.)

  1. Infection Control-Bloodborne Pathogens-Isolation Precautions-Pharmaceutical Waste Reviewed & Updated 4/14/2017
  2. HIPAA Confidentiality and Compliance Orientation Reviewed & Updated 4/14/2017
  3. Patient and Caregiver Safety Reviewed & Updated 4/14/2017
  4. Professional Expectations in the Workplace Reviewed & Updated 4/14/2017
  5. Clinical Skill Awareness and Validation Reviewed & Updated 4/14/2017
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The following forms were reviewed by GGBHA Clinical Subcommittee members on 4/14/2017.