Please review the following information and complete the required documentation.

Student Orientation Handbook: This contains practice guidelines to assist your clinical experience at Madison Memorial. Study and become familiar with all the content in this handbook prior to beginning your clinical experience. Open the link and review this information now. Click here to open.
Short-term Orientation & HIPAA: This orientation will help you be compliant with regulations in our hospital, and help you successfully perform your duties.

Medical PA NP Students

What is your full name?

What school are you applying from?

What is your email address?

What is your phone number?

What is your clinical area of practice?

Handbook Handbook I have studied the Student Orientation Handbook and I will use it as a guide to help my performance at Madison Memorial Hospital.

Orientation Orientation I have completed the Short Term Orientation above and I will act according to the training therein concerning the following subjects: Codes, Confidentiality / HIPPA, Customer Service, Dress Code, Electrical Safety, Ethical Guidelines, Fire Safety, Hostile Work Environment, ID Badge, Infection Control, Paperwork, Security and Workplace Violence, Sexual Harassment in the Workplace, Standard Precautions: Blood and Body Fluids, Tuberculosis & Drug Testing, Working Safely and Your Back, Working Safely with Hazardous Chemicals/MSDS Information, Professionalism and Customer Service.I understand that failure to comply with Madison Memorial Hospital Practices could result in disciplinary action including termination of my clinical experience (contract), and I take full responsibility/liability for my actions.

HIPAA HIPAA I will protect all patient's legal rights to privacy concerning his/her medical information. I understand that confidential information also includes all non-public and private information belonging to MMH. This may include but is not limited to: information associated with business and operations, donations, donors, employees, recipients of service, and Personally Identifiable Information whether written or oral. It is my obligation as an employee/agent of Madison Memorial Hospital to protect this right. I hereby certify that I have read and understood the HIPAA Privacy Training in the Student Handbook and the Orientation above and agree not to disclose any confidential information about a patient or the hospital without consent. This includes discussing, removing, disclosing, or photocopying any information, which I may encounter during the course of my service, contract, or employment that is not directly applicable to my specific job duties. Also, I will not access patient information that is not directly related to my job duties. This applies equally to after I terminate my service with Madison Memorial Hospital. Upon request, I will return to MMH all confidential information. This includes but is not limited to all confidential copies, notes, memoranda, and electronic media that I received, created, reviewed, or obtained. All work products developed while performing services shall be the exclusive property of MMH. I understand that it is my duty to promptly notify MMH if required by any law, court order, or subpoena to disclose confidential information. Any confidential information given to a third party must be approved by MMH. I will promptly notify MMH of any unauthorized disclosure of confidential information that comes to my attention whether on the job or in the community. I understand that such a breach of confidentiality may constitute disciplinary measures and/or termination of my services at Madison Memorial Hospital.

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