Download UPMC Office of Advanced Practice Providers

UPMC Office of Advanced Practice Providers
Educational Experiences
Application Checklist
**Please be sure to title your saved documents according to their name on the checklist prior to uploading.
ACT 33 (Child Abuse History Clearance through the Pennsylvania Department of Public Welfare)
ACT 34 (Pennsylvania State Criminal History Record)
ACT 73 (Federal Bureau Investigation (FBI) Criminal History Report through the Pennsylvania Department of Public Welfare)
Official documentation (a certificate or letter from the training agency) stating that you’ve completed approved training in child abuse recognition and reporting requirements.
Note from your health care provider indicating that you have been seen within one year and are physically fit for clinical rotations. This must be on office letter head or a prescription.
Results of a Tuberculin skin test or chest x-ray within one year
Evidence of current Flu Vaccination (only required for students requesting a rotation during the time period of August-March)
Hepatitis B Immunization Record
Rubella Titer Record
History of Varicella Record (either proof of the disease or a copy of your titer)
Certificate of liability insurance (this information can be requested from your program)
Exhibit A
Signed Last Page of the UPP Handbook
Signed HIPAA Compliance Form
HIPAA Quiz
HIPAA Questions
Questions for Identity Theft
Student Agreement, Exhibit A for IMS Codes
Bloodborne Pathogens
Compliance and Ethics Review
Cultural Competence
Emergency Preparedness
EMTALA: Emergency Medical Treatment and Labor Act
Environment of Care 2014
Infection Prevention 2014
Patient Safety 2014
Staff Privacy and Security Obligations
Team Effectiveness
Clinical Support Module