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Respiratory Therapy Program


Clinical Forms
  Once a student knows his/her clinical assignment the student needs to print out the specific clinical paperwork and bring all signed originals to the RT Office.  All paperwork is due immediately once the clinical assignment is final.

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 to the RT Office.  If paperwork is not in  or before the the first week of August 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 RT office. There are 3 forms for Alvarado that students need to turn it as a complete package.

Also, the student must 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 and is not open on weekends.
      HIPPA (Read through, Print last page & sign)  (Print page 38)
      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 RT 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  few 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. Scripps La Jolla


     Confidentiality Of Information Form

     Scripps PowerPoint

     Parking and Driving Direction




 4.  VA Healthcare System - All paperwork is to be turned in to RT office.

      VA New requirements for Fall 2012

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


Please check the link below :

DataArc Student Instructions


Clinical Instructors

DataArc Instructions for Clinical Instructor

Incorporating Inter-Rater Reliability into Your Curriculum

Incentive Spirometry Evaluation

Procedural Competency Evaluation for Clinical Instructors

Remediation Referral-Academic

Remediation Referral-Clinical

Mandatory Remediation Plan

Clinical Grade Worksheet

Pathophysiology Report Grading Rubric

  Respiratory Therapy Logo

Grossmont College
8800 Grossmont College Drive
El Cajon, CA 92020

Counseling Office

Admissions & Records Office

Respiratory Therapy
(619) 644-7448

Respiratory Therapy

Health Professions Home Page

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