Download Clinical Requirements Checklist Student Information Sheet Proof of

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.)