Student Safety / Compliance / Privacy Pledge
Please review and acknowledge the safety, compliance, and privacy standards required for students at St. Anthony Hospital.
Full Name
*
First Name
Last Name
Email
*
example@example.com
Expected Student Experience Start Date
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Month
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Day
Year
Date
Expected End Date
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Month
-
Day
Year
Date
I acknowledge that I viewed and understand the information provided in the St. Anthony Student Orientation video. I have asked my preceptor to clarify any questions.
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Yes, I acknowledge and understand.
I recognize the importance of maintaining the confidentiality of patients and residents at St. Anthony Regional Hospital and Nursing Home, and of assuring their right to privacy.
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Yes, I agree.
I, therefore, pledge that I will not divulge any information about a patient or resident with persons in or out of the hospital or nursing home facilities unless the other party has a professional need to know.
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Yes, I agree.
I understand that St. Anthony may require my educational institution to attest to my criminal history background prior to me being permitted to participate in the program at St. Anthony.
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Yes, I pledge.
I agree to disclose any change in status to criminal background history and understand that such changes in status may preclude my ability to participate in the program at St. Anthony.
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Yes, I pledge.
Signature
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Submit Pledge
Submit Pledge
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