MH-Pre-Clinical Documents

MEMORIAL HERMANN HEALTHCARE SYSTEM

Prior to the clinical assignment at Memorial Hermann hospitals, the following requirements must be completed and submitted.

Review the following Orientation packet:

MHHS Student Orientation Packet 

Requirements: 

  • Standard Verification (must be completed by school/institution, submitted typed, do not PDF and submitted per semester)
  • Vaccine-QPSIC Flu Instructions (must be reviewed prior to completing the Flu Registration spreadsheet)
  • Vaccine-QPSIC Flu Registration (must be completed by school/institution, submitted typed, do not PDF, to be used only during the flu season (9/16 to 3/31), and submitted in addition to the standard verification form)
  • BulkNonEmpProvision - Password request for Memorial Hermann University (MHU) to complete the online modules "Understanding HIPAA" and Corporate Compliance"; additionally utilized for access to the electronic medical record if indicated for the rotation.
  • Please note: if during a previous rotation you submitted the PiL modules, HIPAA 1-5 and HIPAA Privacy and Security, these are acceptable for one year from the date of completion and you will not be assigned the MHU modules at this time. Should the year time frame expire during your rotation, you will be notified to complete the MHU modules; failure to complete will result in loss of EMR access. In addition, if a new MHU account, you may have to wait 36-48 hours before able to access the assigned modules. 
  • Student Required Documents (must be reviewed, printed, signed and submitted)
  • Submit a copy of your current professional license, if applicable. 
  • Student Emergency Contact Form - required completion and submission for all students with one exception, high school students
  • High School Waiver - required completion and submission for all high school students 
  • 3rd Party Signature Addendum - If the preceptor is NOT a Memorial Hermann or University of Texas employee (e.g. physician, NP, or PA), 3rd party agreement must be signed by the preceptor.
  • UT Supervision Agreement - If the preceptor is employed by University of Texas,(e.g. physician, NP, or PA), a UT Supervision Agreement is required. The school will initiate the provided form and obtain approval/signature by their legal counsel, obtain the preceptor's signature, and then provide the signed copy to the student coordinator who will assume responsibility for the final UT signature. Note: UT Houston students are excluded from this process. 
  • Checklist of Completion for Requirements 
  • HIPAA D  HIPAA Attachment D (for Volunteers, NOT STUDENTS
  • Standards of Conduct Volunteer Acknowledgement (for Volunteers, NOT STUDENTS)
  • Media Consent for Orientation (for Volunteers, NOT STUDENTS)
  •  HIPAA C - HIPAA Attachment C (for contracted and agency personnel, NOT STUDENTS)
  • If a faculty member will be on the campus, having student oversight during the clinical rotation the same documents as the student's apply to the faculty and must be completed and submitted prior to the assignment.

     

    Resources:

    MHU Online FAQ

    Memorial Hermann Orientation Process

     

    About Us

    The Nursing Resource Center is a suite of Internet-based services that helps maximize nursing education capacity by streamlining placements and exposing new opportunities for school-clinical facility relationships.

    Contact Us

    For more information on joining the Texas Nursing Resource Center, please contact:

    Houston-Galveston

    Trish Richard, RN, PhD
    T: 409.772.8221 
    E: plrichar@utmb.edu

    North Texas

    Sally Harper Williams
    T: 469.648.5030
    E: swilliams@dfwhcfoundation.org


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