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)
  • BulkNonEmpProvisionBul - Password request for Memorial Hermann University (MHU) to complete the required online modules "Understanding HIPAA" and Corporate Compliance" required by all students; additionally utilized for access to the electronic medical record if indicated for the rotation.
  • 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

 

LINKS

 

MH-TMC New Employee Orientation 

For Volunteer Services Only: 

Volunteer Orientation

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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