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Clinical Requirements Checklist Student Information Sheet Proof of Legal Presence (Copy of your Arizona Driver’s License or Arizona StateIssued 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 card Copy of your Health Insurance card or letter stating that you do not have insurance. Copy of your American Heart Association Basic Life Support for Healthcare Provider Card (Cost - $25.00 cash or check made payable to HOSA. Classes provided. Link to sign up for classes is on our website.) Fingerprinting Arizona Fingerprinting Services (Cost: $15.00 Cash Only) Mobile service will provide fingerprinting in class. Level 1 Fingerprint Clearance Card Application (Cost: $67.00 cash or check made payable to HOSA.) Negative drug screen results (Cost: $36.00 paid to lab – Instructions will be given in class.) ARCpoint Labs of Phoenix – Black Canyon 2830 W. Glendale Ave Suite 17 Phoenix, AZ 85051 602-888-2351 Physical examination with doctor’s clearance to participate in HCE program (See form provided) TB PPD/X-Ray – Tuberculin skin test within the past 12 months or documentation as a previous positive reactor or negative x-ray. MMR - Proof of rubella and rubeola immunity by positive antibody titers OR 2 doses of MMR Hep B - Evidence of the series of three Hepatitis B vaccinations Tdap – Must have been done within the last 10 years Varicella – Varicella immunity, by positive history of chicken poxs or proof of Varicella immunization. Flu Vaccination (ONLY during time required by hospital or healthcare facility) 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: o o o o o o o o o o o o o o Student Parking and Maps Exhibit A – Statement of Responsibility Exhibit B – Statement of Accountability Information, Privacy ,Security, and HIPAA Training Consent Tenet Ethics and Compliance Policies Consent Corporate Compliance Module HIPAA Module Infection Control Module Patient Safety Module Professional Conduct Module Professional Conduct Final Assessment Patient Safety Final Assessment Infection Control Final Assessment Corporate Compliance Final Assessment Student 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.)