Orthopedic Technology
             (619) 644- 7550

                  Email:  OrthopedicTechnology


Orthopedic  Technology/Clinical

Clinical Forms

Once a student has been assigned to his / her clinical site the student needs to read and  print out the specific clinical paperwork and bring all signed originals to the Health Professions Office. All paperwork is due immediately once the clinical assignment has been finalized.

The student is responsible for making copies of all forms turned in to the Health Professions Office prior to submission of the forms. Original forms are not returned to student.

If your clinical site is not listed you will be doing the paperwork at the facility with your clinical instructor.

Student is responsible for getting all paperwork completed and turn it to Health Professions Office. If paperwork is not in before the due date ( the first week of August 2013) for Starting Fall  2013, student will not be eligible to go to assigned clinical rotation as arranged.

1. Alvarado Hospital: all paperwork is to be turned in to Health Professions Office.

Go to hospital at least 1 week prior to your 1st day to get your badge.
HR is across the street on Reservoir Drive first floor.

HIPPA (read through, print last page  & sign)
Confidentiality Statement (add your name, print & sign)
Statement of Responsibility (add your name, print & sign)

2. Sharp Healthcare: All paperwork is to be turned in to EKG office.

There are 5 forms for Sharp that students need to turn it as a complete package.

   1  Student Placement Request (add your name, print & sign)
   2  Certificate of Understanding (add your name, print & sign)
   3  Confidentiality Statement (add your name, print & sign)
   4  Student Compliance Answer Sheet


Sharp requires students to review the next  PowerPoints and then take  the test.


 5 HIPAA Community Privacy Education (Print page 45)  

     HIPPA Community Privacy Education Test

     Always Events: Hand Hygiene

     Always Events: Hand Hygiene Test

     Always Events: Line Tracing

     Always Events: Line Tracing Test

     Always Events: Patient Identification

     Always Events: Patient Identification Test

     2013-14 Compliance: Ethics

     2013-14 Compliance: Ethics Test

     2013-14 Compliance: Fraud & Abuse

     2013-14 Compliance: Fraud & Abuse Test

     2013-14 Compliance Information Security

     2013-14: Compliance: Information Security Test

     2013-14 Compliance Safeguarding privacy

     2013-14: Compliance: Safeguarding Privacy Test

     Fall Prevention

     Fall Test

     2013 National Patient Safety Goals (Read and Initial)

     Patient Safety

     Patient Safety Test 

     Parking Directions - All locations  ( for your information only)



3. VA Healthcare System: All paperwork is to be turned in to CTE Office

Do items 1-4 - Type all information (NO HANDWRITING ON PAPERS except for signature) or sign and bring to CTE Office.
Declaration for Federal Employment OF 306
Application for Health Professions Trainees VA 10-2850d
EES Librix Online Learning Website: https://www.ees-learning.net
(read and print 2 certificates, sign and return)
VA National Rules of Behavior (NEW)


Print Your Clinical Experience  Report Sheet Here






Grossmont College