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
- 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", "Corporate Compliance" and "Effective Communication for Patients and Companions with Language and Other Communication Barriers"; 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
ONLY FOR THE STUDENT IN THE "VACCINATOR" ROLE:
The following (2) forms must be initialed/signed by the student/faculty and returned to MHHS Student Site Placement Coordinator. Please remember these are in addition to meeting the standard student requirements listed above; student vaccinator education resources should be reviewed prior to arrival on campus.
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.
ONLY FOR VOLUNTEERS:
The following forms must be initialed/signed by the volunteer and returned to the Volunteer Office as instructed by their campus volunteer leader.