TriStar Observational Experience Request Form

Please review Eligibility before submitting, to ensure that you are selecting the appropriate program for your individual situation. Please DO NOT submit duplicate requests, this will only delay processing. If you are concerned that your application was not recieved, please email or call Alicia Morris at alicia.morris@hcahealthcare.com or (318) 547-1805.

Thank you for your interest in TriStar Observational Experience Program "T-OEP". The goal of the program is to assist undergraduate students and members of the community to navigate opportunities within TriStar. The individual will have the opportunity to shadow a TriStar clinician or employee, for the approved time period. Program participants will be able to witness firsthand the occupational, educational and interpersonal skills required for the role.

High School students are not eligible for this program. Observation requests for high school students should be submitted via the following link:

https://form.jotform.com/233522754900150.

All other observation requests for clinical advanced practice providers (e.g. Nurse Practitioners, Physician Assistants and physicians), clinical- non advanced providers (e.g. Nursing (RN), Imagining, Pharmacy, Physical and Occupational Therapy) and non-clinical employees should continue with the questionnaire below.

Applicant Eligibility:

- Individual must be at least 18 years or older to participate
- Request to shadow must be submitted at minimum of 14 days in advance of shadow date

- Observers are required to identify their sponsoring clinician, and schedule their observation date prior to submitting this request for approval. We do not assign sponsors to applicants.
- Opportunities are scheduled based on the timeframe requested by the participant, and approved by the Clinician.
- Participants will be under the direct supervision of the designated Clinician at all times
- All shadow experiences are NO HANDS-ON patient contact.

The following individuals do-not meet program eligibility:

High School Students
Initial Credentialing Applicants

Clinical Requirements:

Program application with participant information
Acceptance of Risk and Release of Liability
Confidentiality and Security Agreement
Proof of immunization (TB, Flu, and MMR)*

*Proof of Flu vaccination is only required during flu season; MMR is required for participants requesting to shadow in a Kentucky facility only.

Program Limitations:

Observerships are limited to a Maximum of 40 hours, which may be scheduled as:

A consecutive work week of up to 5 days
Up to 5 Days spread over a period of no more than 30 days

If you have any questions or concerns regarding an observation with TriStar Healthcare, please reach out to Alicia Morris at alicia.morris@hcahealthcare.com or (318) 547-1805.

Are you an HCA Healthcare Employee?*

If you answered "Yes" to the previous question, at what facility do you work?

Are you 18 or older?*

YesNo

Have you scheduled this observation with the individual you will be shadowing?*

YesNo

If your answer to the previous question is "No", please do not submit this form. You are responsible for scheduling your observation experience with the sponsoring clinician that you have chosen, prior to submitting this form.

Name*

First NameLast NameSuffix

Title*

Email*

example@example.com

Phone Number*

Please enter a valid phone number.

Mailing Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Emergency Contact Person*

Emergency Contact Phone Number*

Please enter a valid phone number.

In which Facility would you like to observe?*

Department To Be Observed*

Date of Observation*

Please schedule this with your sponsor prior to submitting.

Sponsoring Clinicians First and Last Name*

Sponsoring Clinicians Email