Job Shadowing at wmmc

As a job shadow/observer applicant, I will agree to abide to the following:

In making this application to job shadow/observe at Western Missouri Medical Center (WMMC), I understand that I must abide by all WMMC policies and procedures. I will follow any unit specific rules that are explained to me.

I will dress appropriately as specified by my assigned department/unit. NO low-cut, low hanging, spaghetti strap tops, NO hoodies, NO blue jeans or shorts and NO flip-flops will be worn.

I understand that I must always wear a name tag while I am at the Medical Center job shadowing/observing during the date agreed upon.

I understand that any action unbecoming will not be tolerated. The use of obscene language will not be tolerated. WMMC is a tobacco-free environment, thus no tobacco products will be allowed in or on any owned or leased buildings, grounds, parking lots, ramps, plazas, vehicles and sidewalks adjacent to our properties.

I will not damage, deface or destroy any WMMC property. If this occurs, I may be held responsible for any/all damages.

I agree to be punctual and conscientious. I will treat others with dignity, courtesy and consideration.

I understand that I may compromise the health of the patients, staff and visitors if I am experiencing any of the following conditions: upper respiratory infection, diarrhea or skin lesions. Thus I will not come to WMMC and will call Human Resources to let them know I will not be coming on the designated day(s). Additionally, I understand that if these conditions occur during my assigned hours, if appropriate, I may be asked to leave the Medical Center.

I understand that approval for this program Is for a specified length of time and that failure to meet any of the requirements shall cause approval to job shadow/observe to tie forfeited.

I understand that while job shadowing/observing I may be exposed to patients who have contagious diseases as well as to blood and bloodborne pathogens. I accept this risk and should I contract an illness from such exposure, hereby release Western Missouri Medical Center from any liability.

I understand that if an accident should occur while job shadowing/observing, I accept the responsibility for any medical treatment and/or expenses which may be required, hereby release Western Missouri Medical Center from any liability.

I agree to abide by the above conditions and by not doing so could result in dismissal from my job shadowing/observing opportunity at Western Missouri Medical Center.

OVERVIEW OF PRIVACY POLICIES

Western Missouri Medical Center (“WMMC”) policy and federal regulations protect the privacy of our patients’ health information. The Health Insurance Portability and Accountability Act (HIPAA) is a set of federal rules that defines what information is protected, limits how that information may be used or shared, and provides patients with certain rights regarding their information. WMMC has its own policies that reflect these regulations as well as best practice standards.

These rules protect information that is collected or maintained (verbally, in paper, or electronic format), that can be linked back to an individual patient and is related to his or her health, the provision of health care services, or the payment for health care services. This includes, but is not limited to, clinical information, billing and financial information, and demographic/scheduling information. Even the fact that an individual has received care at WMMC is protected by WMMC policy and federal regulations.

WMMC policy and HIPAA regulations limit the use or sharing of protected patient information to the following purposes: providing treatment, obtaining payment for services, certain health care administrative functions and when required or permitted by law. Any other use or disclosure of protected information requires written authorization from the patient. For all uses or disclosures other than treatment, only the minimum amount of information necessary will be shared on a need to know basis.

CONFIDENTIALITY AGREEMENT

As a visitor at WMMC you are required to conduct yourself in strict conformance to all applicable laws and WMMC policies governing confidential information. For example, simply by being in a WMMC facility, you may encounter confidential information about patients. Care is often coordinated in semi-public environments where there is the risk that patient information may be heard or viewed by individuals not directly involved in the patient’s care. WMMC has polices intended to limit the risks of such incidental disclosures of patient information.

Any patient or other confidential information you see or hear, either incidentally or by attending rounds, must be kept confidential. By signing below, you are agreeing to abide by WMMC policies regarding confidentiality of patient health information and any other non-public WMMC information.

As a condition of and in consideration of, my use, access, and/or disclosure of confidential information, I understand and agree to the following:

• I understand that I must respect each patient's and staff member's privacy and right to confidentiality and will not seek information regarding specific patients. I will not discuss with anyone outside of the organization, names or information I may come upon during my experience here.
• I understand I must keep confidential any information I may observe during the course of my job shadow/observe experience. If a violation of privacy does occur even after the experience, your school/college may be in jeopardy of not being allowed to send students in the future to intern at WMMC.
• I will access, use, and disclose confidential information only as permitted by WMMC hosts. This means that I will only access, use, and disclose confidential information that I have been given authorization to access, use, and disclose.
• I will not share protected health information or other confidential information with anyone who is not authorized to have access to it. I will not share this information with other persons, even in casual conversation.
• I understand that any fraudulent application, violation of confidentiality or any violation of the above provisions will result in the termination of my privilege to observe and participate in rounds in clinical areas and I may be subject to legal liability as well.
• My signature below indicates that I have read, accept, and agree to abide by all the terms and conditions of this Agreement and agree to be bound by it.