Colquitt Regional Medical Center Job Shadowing Application

 
Once the application is received and approved, the student will be scheduled an appointment with Colquitt Regional Employee Health for a:
 
-TB skin test
-Drug screen
 
[Note: A parent may be required to attend these appointments]
 
Required Training:
-Prior to shadowing, the student must complete an online orientation before being issued an Identification Badge which must be worn while on any Colquitt Regional campus during the entire shadowing period.
-If the student is shadowing in sterile areas, the learner observing is required to attend sterile practice training at Colquitt Regional Medical Center prior to beginning the shadowing experience.
 
Responsibilities & Prerogatives:
-Student shall remain with the approved Medical Staff Member or with other practitioner(s) as directed by the approved Medical Staff Member at all times while at Colquitt Regional Medical Center.
-Student may observe as authorized by the approved Medical Staff Member.
-Students shadowing may not participate in examination, care, or treatment in any way.
-Student shall comply with Colquitt Regional’s policies and procedures, including but not limited to, policies protecting patients’ privacy and confidentiality.
Student shall wear a Colquitt Regional Medical Center ID badge, identifying the learner as a Sadowing Individual at all times when at Colquitt Regional Medical Center. 
-Student is excepted to turn in their Colquitt Regional Medical Center ID badge at Human Resources upon cessation of the learner’s observation experience.
 
If you have any questions, please contact Autumn Horne at 229-890-3426 or aucor@colquittregional.com.

I understand and acknowledge that Colquitt Regional Medical Center has agreed to allow me to shadow professionals at its facilities based on my interest in exploring a potential career in health care. In consideration of allowing me this opportunity to participate, I understand and agree to the following:
 
 Shadowing is limited to following and observing a medical professional as they perform their job duties.  I will not have unsupervised access to patients.
 
 While on Colquitt Regional’s premises, I will abide by all policies, rules, and regulations and will follow the direction of the co-worker to whom I am assigned.
 
 I understand cell phone use is prohibited during my shadowing period. I understand photography is not permitted at any time during my job shadowing period.  I understand, I am not to post descriptions from my shadowing experience on social media.
 
 I will not be permitted in areas of contamination. I will not touch medical equipment. I will not access medical records, charts, or computers.
 
 I will not assist in feeding but may help deliver food to patients.
 
 I will wear my issued badge and will dress professionally as outlined in the attached dress code policy.
 
 I will abide by infection prevention policies and will not participate in the program when I am sick or experiencing the onset of signs and symptoms consistent with illness.
 
 I agree to release, indemnify, and hold harmless Colquitt Regional Medical Center and its officers, agents, co-workers, attorneys, subsidiaries, affiliated entities, predecessors, successor organizations, insurers, and assigned Colquitt Regional entities from and against any and all responsibility and obligation for my participation in the job shadow program.
 
 I understand that I will be in a facility where patients are being treated.  And, as part of the job shadow program, I may come into contact with patient information.  I understand Colquitt Regional is obligated under both federal and state law to keep patient information confidential.  I further understand that if I encounter patient information through the course of the job shadow program, it is solely for the purpose of demonstrating concepts of principles, and not for the purpose of disclosing patient’s information, condition, diagnosis or treatment.  I understand that all information about patients, whether it is medical or personal, is absolutely confidential and I will not discuss or repeat anything that I see, read, or hear. I have read and signed a confidentiality agreement wherein I agree to keep all patient information private and confidential.
 
 I understand that Colquitt Regional may remove me from my job shadow program for any reason, or no reason at all. This may include, but not limited to:  My failure to abide by terms of this agreement or Colquitt Regional’s policies, my failure to act in a responsible and mature manner or if Colquitt Regional believes it is in my best interest, the best interest of its patients and co-workers.
 
My signature indicates that I have read, accept, and agree to abide by all the terms and conditions of the Agreement.

Depending on the area in which you shadow, appropriate job shadowing attire includes:
 
Males
-Collared shirt
-Black/Navy/Khakis (appropriate fitting) pants with belt and shirt tucked in
-Comfortable shoes for standing/walking – must be closed-toe or have a strap across the heel.
-No jeans, no t-shirts, no flip flops
 
Females
-Conservative blouse/top
-Black/Navy/Khaki (appropriate fitting) pants
-Comfortable shoes for standing/walking - must be closed-toe or have a strap across the heel.
-No jeans, no t-shirts, no flip flops
 
Clothing Styles
Professional business attire including dresses, skirts, blouses, shirts, sweaters, trousers, slacks, and suits. Hemlines on dresses and skirts should be no more than 3 inches above the knee (index card test), and splits in skirts should be conservative. Hemlines on pants/slacks should be no more 3 inches above the ankle.  Blouses, shirts, and sweaters should be worn inside the waistband and or should extend well past the waist so as not to expose the midriff when arms are raised above head.  Sleeveless attire is not appropriate. Culottes and split skirts are permissible. Leggings that are no more than 3 inches above the ankles are allowed if a dress meeting the hem requirement is worn over the leggings. To clarify further, long tops/blouses/tunics over leggings are not allowed. Males should wear dress slacks/khakis with a collared shirt. Coat and tie as appropriate. Clothing made of jean or denim-like material is inappropriate. If hosiery and socks are worn, they should coordinate with attire.
 
Tattoos
Tattoos must not be visible while shadowing and must be covered in the most professional appearance possible.
 
Nails
Nails must be clean and properly maintained.  Nail polish should be conservative and appropriate to the work setting, well-manicured and not chipped or peeling.  For those having contact with the patient or the patient’s environment, artificial fingernails of any type are prohibited and should be natural nails only.  Natural nail tips should be less than ¼ inches long.  
 
Clothing Appearance
Clothing should be clean, neat, not faded and fit appropriately.  Proper undergarments must be worn and panty lines should be invisible.  Bralettes or bra straps should not show.  It is not appropriate for cleavage to be visible.
 
Jewelry
Jewelry must be conservative and simple. Earrings may not be worn by males. Females may wear up to three earrings per ear. Rings and studs visible in areas other than the ear are not permitted.  No gauged earlobes or industrial bar piercings.
 
Shoes
Shoes worn should not present a safety hazard. Shoes should be clean, and presentable.  Flip flop style shoes (rubber, Yellow box brand, beach style) are not appropriate. Over the knee boots are not permitted.

As a participant in the job shadow program, I agree to the following:       
 
I understand that I am responsible for complying with HIPAA privacy policies of Colquitt Regional Medical Center.
 
I will respect patient privacy and will not access patient information.
 
I will not disclose information regarding the Medical Center’s patients to any person or entity as it is permitted under the Medical Center’s HIPAA policies.
 
I will report any privacy concerns to the Medical Center’s compliance officer by emailing Jessica Jordan at jjordan@colquittregional.com
 
I will not attempt to access patient health information or eavesdrop on discussions of patient information.
 
I will not take photographs of any kind during my shadowing experience.
 
I will not post photographs or descriptions from my shadowing experience on social media.
 
I will not log on to any of the Medical Center’s computer systems that currently exist.
 
I will not take or remove a patient information from the premises.
 
I will not reference patient healthcare information in my school coursework.
 
I will not discuss patient healthcare information in public areas that could be overheard.
 
Upon cessation of my shadowing experience, I agree to continue to maintain the confidentiality of any information I learned during my experience and agree to turn over my identification badge, any keys, access cards, or any other device that would provide access to the facility.
 
My signature indicates that I have read, accept, and agree to abide by all the terms and conditions of the Agreement. I understand that violation of this agreement could result in legal actions: