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2020 - CONFIDENTIAL
Clinical Education, Practice and Informatics
Elijah T. Clayton, Learning Consultant - Academic Placement
250 Hospital Parkway
San Jose, CA 95119 | Fax (408) 362-4384
Kaiser Permanente San Jose/Gilroy Medical Centers
Clinical Student Packet
Student Requirements
Requirements:
KP Learn modules: • Annual Compliance Training 2020• Safety Training and Environment of Care (Hospital California Initial Assignment) 2019• Protecting Health Information (PHI) at KP
Remember to Print Out Certificate of Completion for each module and attach them to the packet
Regulatory Forms (all pages filled in): • HIPAA Privacy and Security Rule• Confidentiality Agreement• Kaiser Members and Patient Rights and Responsibilities• Guidelines for Standard/Universal Precautions and Protection against Exposure to Bloodborne Pathogens in HealthCare
Settings• Elder and Dependent Adult Abuse• Child Abuse Reporting Requirements• Spousal/Partner Abuse (Domestic Violence) and Deadly Weapon/Criminal Injury Reporting• Student/Travelers Rights• Student/Travelers Rights Request
Affiliated School Checklist for Students (Health Clearance): • Attached results for TWO TB tests• (A 2 step, or 2 consecutive years)• IF TB IS POSITIVE:
o Chest X-Ray less than 5 years oldo Symptom Free Review form from current year (signed)
• Attached results for Measles vaccine/titer• Attached results for Rubella vaccine/titer• Attached results for Mumps vaccine/titer• Attached results for Varicella vaccine• Attached results for Hepatitis B vaccine• Attached results for TDaP (within the last 10 years)• Attached copy of FLU vaccine (current Flu Season) (Required ONLY during Flu Season)
Attached letter from School stating Background Check and Drug Screening results are clear
Attached copy of current CPR card (must be an AHA approved BLS provider)
Completed During Orientation:
Obtain HealthConnect initial password
Obtain Kaiser Permanente badge (Must be returned at the end of rotation to school instructor)
Obtain a proof of Flu shot sticker from Employee Health Department (during KP identified flu season)
Complete Unit/Department Orientation with manager or preceptor/designee Return completed form to Clinical Education, Practice, and Informatics Department Designee
Requesting NUID and HealthConnect Access Log In: 1) Submit NUID application form and Health Connect access request form to the Clinical Education, Practice
and Informatics department coordinator six weeks in advance of rotation start, even if the studentrequires HealthConnect access.
2) All information is required for new and returning students each calendar year.3) Accessing to KPlearn to complete the required modules instructions:
►1. Enter http://learn.kp.org into yourInternet Explorer browser address.
►2. Click on the green button: Log into KP Learn.
►3. You will be redirected to Single Sign On:
If it is your first time logging in, pleaseActivate your account.
If you are returning, type in your NUID as theUser ID along with the password you created.Once logged in, you will see your home page.
►4. To search the Learning Catalog for the course, type inAnnual Ethics and Compliance Training 2019, or “AnnualOSHA Safety Training for California (Hospitals and MOBs)and Hawaii Hospital (includes EOC _ Waste_PWV) 2019", inthe search field box and click Go.5. Allow approximately 90 to 120 minutes to complete each ofthe trainings. If you need to interrupt your training, see Steps 7 –9
►6. When you find the course “Annual Ethics andCompliance Training 2019,” click Launch.
*Note: The “Offered As:” section must say “WebBased Training” in order for the training to properlywork.
You will also complete: “Annual OSHA Safety Training for California (Hospitals and MOBs) and Hawaii Hospital (includes EOC _ Waste_PWV) 2019"
►7. To properly exit a Web-based trainingmodule, use the course navigation buttons.
If you need to leave the course website before you finish the course, click on the EXIT button at top right of the screen.
DO: Use the course navigation exit buttons to receive credit for course completion.
DON’T: Use the browser window close button as this may result in no completion credit.
►8. Then log in again at Learn.kp.org when youare ready to resume.
►9. Under Enrollments click on “Launch Now” forAnnual Ethics and Compliance Training 2019, orAnnual OSHA Safety Training for California (Hospitals and MOBs) and Hawaii Hospital (includes EOC _ Waste_PWV) 2019". You will be returned to your last completed section.
► 10. Remember to print out your Certificate ofCompletion for all the modules completed. That isyour proof of completion and a required item toinclude in your packet. You can access them at anytime from the Transcript tab.
If you are having difficulty accessing or using KP Learn, please call the Help Desk.
Please note that the Student Placement Coordinator is unable to assist you with access troubleshooting.
If you are unable to print out your Certificates of Completion, notify the Student Placement Coordinator, during orientation.
250 Hospital Parkway Nursing Administration
San Jose, CA 95119
Elijah T. Clayton, Learning Consultant [email protected]
Welcome to Kaiser Permanente San Jose/Gilroy Medical Centers
Name NUID# School/Agency__________________________
Instructor Department: ___________________ Date_____________
I have read and understood this material. (Student/Traveler Signature)
All 2020 Students, and Student Shadow Student, and faculty/Staff are required to complete packet upon on-boarding.
Each year, this packet is updated to include new and important information. This self-study module has been designed as a review of information on the topics below. As soon as you receive this self-study packet, please review the information. If you should have any questions, please ask your instructor for clarification.
After completion of these documents, please return them to your instructor, for review. The School will submit them to the Kaiser Permanente Clinical Education, Practice, and Informatics Department, either in person, email or fax.
Inpatient Nursing [email protected]
Medical Centers – San Jose/GilroyChecklist for Nursing Faculty and General Student Placement
Submit your paperwork after all items listed below are completed as a single packet. Make sure all documents are legible and were filled out using blue or black ink. PLEASE DO NOT CURSIVE
HEALTH RECORDS SHOWING YOU’VE MET THE FOLLOWING REQUIREMENTS TB Skin Test (PPD), Interferon or Chest X-ray results Mumps, Measles, and Rubella (MMR) Titer or vaccinations Varicella (Chickenpox) Titer or vaccinations Hepatitis B Titer or vaccinations Tetanus, Diphtheria & Pertussis (TDAP) Titer or vaccinations Flu immunization for current year
ATTESTATIONS – READ, SIGN AND DATE Affiliated School Checklist For Students Confidentiality Agreement (3 pages) Health Connect Confidentiality Non-Disclosure Agreement Guidelines For Standard/Universal Precautions Child Abuse Reporting Requirements Elder And Dependent Adult Abuse Reporting Requirements Influenza Vaccine Hepatitis B Vaccine Tetanus, Diphtheria & Pertussis (TDAP)
KP LEARN MODULES Annual Ethics and Compliance Training 2019 (all Students) Preventing Health Care Acquired Infections (all Students) Preventing Surgical Site Infections (Surgical and Sterile Processing Tech Students) Preventing Central Line Infections (Surgical and Sterile Processing Tech Students) Annual OSHA Safety Training for California (Hospitals and MOBs) and Hawaii Hospital (includes EOC _ Waste_PWV) 2019"(all Students)
ADDITIONAL PAPERWORK TO BE SUBMITTED Photo ID Badge Request (in person) Background Check Clearance (letter from school or actual report) 10-panel Drug Screening Clearance (letter from school or actual report)Copy of front and back of BLS card (for RN Students) and ProfessionalLicenses (For All Instructors)
Discipline: ______________________ Print Name: _____________________ Date: ____________
Signature: ________________________________ Contact #: _________________
Go to the KPHC Nursing Student Modules Vimeo albumfound here: https://vimeo.com/album/41318571
2Enter the password, kphcnursing
https://vimeo.com/album/4131857
3Select a video and press the play button.
Tips & Tricks
For best viewing quality, ensure the video is playing at 720 HD.
To practice your skills, be sure to launch the skills practice version of the videos by clicking the link in the video’s description.
KPHC OnlineCampus Training · Getting Started· Preparing for Your Shift· Introducing Patient Lists· Working with Patient Lists· Introducing Flowsheets· Vital Signs and Pain· Critical Notification· Documenting Point of Care Tests· Introducing the Medication Administration
Report (MAR)· Starting an IV Line· Patient Education· KPHC Resources
Look for the mouse icon on avideo’s splash screen.
STUDENT PRECEPTORSHIP PROGRAM San Jose Medical Center
KAISER PERMANENTE 1/2/2020 1/1
Student Placement Request Form – San Jose Medical Center Please type or print with blue or black ink and return by fax or email
SCHOOL INFORMATION
SCHOOL NAME: ______________________________________________________________
DESIGNATED REPRESENTATIVE: _______________________________________________
PHONE CONTACT: ____________________________________________________________
EMAIL CONTACT: _____________________________________________________________
STUDENT INFORMATION
LEGAL NAME: _________________________________________________________________ (First) (Middle) (Last)
ADDRESS: ____________________________________________________________________
PHONE CONTACT: _____________________________________________________________
EMAIL CONTACT: ______________________________________________________________ CLINICAL ROTATION INFORMATION
TYPE OF STUDENT: RN Student SPD Student Technical Student Pharmacy/Pharmacist StudentSPECIFY IF OTHER STUDENT: ______________________________________________
DEPARTMENT(S): _______________________________________________________
PREFERRED LOCATION: San Jose Gilroy
PROSPECTIVE START DATE: _____/______/_______PROSPECTIVE END DATE: _____/______/_______
TOTAL NUMBER OF CLINICAL HOURS REQUIRED: _________________________________
SCHEDULING LIMITATIONS/AVAILABILITY: _______________________________________
INFORMATION BELOW IS REQUIRED FOR NUID & KPHC ACCESS CREATION
DATE OF BIRTH: ____________________ SOCIAL SECURITY NUMBER: ________-________-__________
HAS STUDENT EVER BEEN EMPLOYED BY KAISER: YES NO
HAS STUDENT HAD A PREVIOUS KAISER CLINICAL EXPERIENCE: YES NO
COMPLETE NEXT SECTION ONLY FOR KPHealthConnect CHARTING ACCESS:
STUDENT HAS SUCCESSFULLY COMPLETED KP HC TRAINING: YES NO
STUDENT HAS SIGNED NON-DISCLOSURE AGREEMENT: YES NO
Signature Print Legal Name Date *I certify that I have validated the accuracy of the information being provided
OFFICE USE ONLY
DATE RCVD: __________________REQUEST SENT: ________________ 2nd:________________
APPROVED: _______________ DENIED: _____________ SCHOOL NOTIFIED: ______________
SUBMIT THIS REQUEST FORM 4 to 6 WEEKS PRIOR TO REQUESTED START DATE Elijah T. Clayton, Learning Consultant - FAX: 408-362-4384 EMAIL: [email protected]
NUID: :
San Jose/Gilroy Medical Centers
Please submit form with your requested start date
General Placement Phone: (408) 972-6250 or Fax: (408) 362-4384 Form revised 071015
Health ScreenCOMPLETE FORM AND ATTACH SUPPORTING HEALTH RECORDS
Name:First Middle Last
School: Program:
1. TB Screening provide documentation you met requirement using option a, b or c.a) TB Skin Test (PPD)
Requires 2 Skin tests in 2 years; one within two last two years and one that will cover you during your rotation.
Both Results must be negative If positive, must have Chest X-ray
&TB Result #1 Date Read TB Result
#2 Date Read
b) Chest X-ray Only required if skin test is positive Must have been done in last 2 years Must also complete the annual Kaiser
Permanente Symptom Questionnaire
& Kaiser Annual
Symptom Questionnaire
X-ray Result Date of Result Date Completed
c) QuantiFERON (QFT) results
QFT Result Date of Result 2. MMR provide documentation you met the requirement using option a or b.
a) Titer b) Vaccination Must have 2 if born after 1957
Measles:Result Date of Result MMR vaccination #1
Mumps: Date of vaccination Result Date of Result
Rubella: MMR vaccination #2 Result Date of Result Date of vaccination
3. Varicella (Chickenpox) provide documentation you met the requirement using option A or B. A history of Chickenpox willnot be sufficient documentation.a) Titer b) Vaccination
Varicella vaccination #1 Date of vaccination Result Date of Result
Varicella vaccination #2 Date of vaccination
4. Hepatitis B provide documentation for option a or b and completed Attestation.a) Titer b) Injection
Part 1 Date of vaccination Result Date of Result
Part 2 Date of vaccination
Part 3 Date of vaccination 5. Tetanus, Diphtheria & Pertussis (TDAP) provide documentation and completed Attestation
a) TDAP Vaccination Immunization once as adult Date of vaccination
6. Flu provides documentation and completed Attestation.a) Flu Vaccination for current flu season (November 1, 2016 - March 31, 2017)
Keep a copy of vaccination to present to EHS on Externship Day One Date of vaccination
San Jose/Gilroy Medical Center Health Screen
Please submit form with your requested start date
General Placement Phone: (408) 972-6250 or Fax: (408) 362-4384 Form revised 071015
Background Screening * Provide documentation student successfully completed Criminal Background Check Clearance
10-panel Drug Screening **Provide documentation student successfully completed a Drug Screening
CPR License (required for certain placements) Provide copy of BLS Healthcare Provider the Certification must be from AHA approved provider.
Professional License (required for certain placements) Provide copy of Professional License card Respiratory Fit Testing (required for certain placements) Has student previously completed N95 Fit Testing? YES on _________ NO
If student is under 18 Provide Minor Treatment Parental Consent form and copy of Work Permit.
* Effective 01/01/2014 Criminal Background Checks are required for all students placed at Kaiser Permanente Medical Center,Outpatient Clinic and Medical Office Buildings in the Greater Southern Alameda Area.
A student with a background check that indicates any of the following felony and/or misdemeanor convictions within the last 7 years is NOT eligible for clinical placement:
- Violent crimes such as murder, rape, sexual assault and robbery, kidnapping, attempted murder, assault with deadlyweapons.
- Crimes involving theft, embezzlement, burglary, forgery, fraud, arson, identity theft.- Sex crimes including sexual molestation and sex crimes against children, or any conviction for which a candidate is required
to register as a sex offender with a state or federal government agency.- Drug related crimes such as drug theft, sales, distribution, manufacturing and possession of controlled substances.- Multiple convictions (more than one conviction for same or different crime).- Name posted on any government sanctioned or debarred list.
** Kaiser Permanente is committed to protecting the safety, health and well-being of employees and other individuals in KP’s workplace and provides an environment that is free from the abuse of alcohol and drugs.
Effective 01/01/2014, documentation of a clear 10-panel drug screen is required for all students. Such a drug screen may be completed on entry into the school’s program, and repeated on resumption of the clinical program at the school if there is a lapse in program matriculation due to leave of absence.
I attest to the accuracy of the above information and, if requested, documentation will be provided on short notice.
Signature (student, parent or legal guardian) Print Legal Name Date
AFFILIATED SCHOOL CHECKLIST FOR STUDENTS San Jose Medical Center (Supplemental information only)
* Criminal Background Check and Drug Screening are required for all students placed at a Northern California Kaiser Permanente Medical Center,Outpatient Clinic/Medical Office Building, Home Health & Hospice, or Appt & Advice Call Center.
Effective 1/1/2008, a student with a background check that indicates any of the following felony and/or misdemeanor convictions within the last 7 years is NOT eligible for clinical placement:
- Violent crimes such as murder, rape, sexual assault and robbery, kidnapping, attempted murder, assault with deadlyweapons.
- Crimes involving theft, embezzlement, burglary, forgery, fraud, arson, identity theft.- Sex crimes including sexual molestation and sex crimes against children, or any conviction for which a candidate is
required to register as a sex offender with a state or federal government agency.- Drug related crimes such as drug theft, sales, distribution, manufacturing and possession of controlled substances.- Multiple convictions (more than one conviction for same or different crime).- Name posted on any government sanctioned or debarred list.
HIPAA PRIVACY AND SECURITY RULE
Completion Statement PLEASE PRINT: LAST NAME, FIRST NAME, MIDDLE INITIAL (As it appears on your paycheck, if known)
Your NUID #, if known:
PHONE NUMBER : POSITION TITLE/ROLE:
FACILITY NAME: DEPT NAME:
PART I - HIPAA PRIVACY RULE TRAINING Course #: CPL:NACPL HIPPRV ILT NCA HIPAA Basics (All employees and physicians must complete). Upon completion of the training you should: • Understand the Health Insurance Portability and Accountability Act (HIPAA)• Understand the definition of Protected Health Information (PHI), and what comprises PHI• Understand the “Need to Know” Rule• Know the rights patients have to understand and protect their PHI• Know the role of the Privacy Officer• Understand the Information Security Program• Understand acceptable use of PHI• Know the compliant process to report privacy abuse• Understand Corporate Compliance within Kaiser Permanente
Signature: Date Completed:
PART II - HIPAA PRIVACY RULE TRAINING
Based upon your job requirements, you may need to take additional HIPAA Training. You are responsible for discussing with your manager what additional training you must take.
I completed additional HIPAA Training related to Work Unit specific HIPAA Privacy Policy Summaries.
Signature: Date Completed:
HIPAA SECURITY RULE TRAINING Course #: CPL: NACPL HIPSEC ILT
I understand that HIPAA Security Rule Training is an important part of Kaiser Permanente’s compliance program and it is my responsibility to complete this course in a conscientious manner. I understand I am expected to comply with Kaiser Permanente’s “Principles of Responsibility” and the HIPAA Privacy and Security Policies. I can seek clarification and guidance about these standards from my manager, my Area Assistant Administrator for Quality Service, the Regional Compliance and Privacy Office and the National Compliance Office. I also understand that I am expected to report any suspected compliance violations, including information privacy or security concerns. I further understand that I am protected from retaliation for reporting such concerns.
Signature: Date Completed:
Please check your classification Routing Instructions Faculty Follow local instructions Clinical Student Follow local instructions Other Student i.e. (Pharm, SPD,
Techs, RAD, etc.) Follow local instructions
5 | P a g e C l i n i c a l E d u c a t i o n , P r a c t i c e a n d I n f o r m a t i c s - A c a d e m i c P l a c e m e n t 2 0 1 6
How to Use Alcohol Hand Sanitizer
• Apply product to palm of one hand• Rub hands together• Cover all surfaces of hands and fingers• Rub until hands are dry• When using alcohol hand sanitizers, you have used enough (about 1/2 tsp) if it takes 15-20 seconds to dry on your
hands
When to Use Alcohol Hand Sanitizer
• When entering or leaving a hospital room• For routine cleaning of hands when they are not visibly dirty• When you have contact with objects in the environment• Before and after you care for or have contact with anyone
• After touching anyone in the hospital (shaking hands, holding hands, especially when the other person has a cold or
other illness)
IT’S OKAY TO ASK STAFF TO WASH THEIR HANDS
Join Kaiser Doctors and staff in keeping your friend or family member safe by performing hand hygiene. How to Wash Your Hands
• Wet hands with water• Apply soap to hands• Rub hands together vigorously for at least 15 seconds covering all surfaces of hands: Front and back Between
fingers Around thumbs Around nails• Rinse hands well to remove soap residue• Dry hands gently using paper towels then use towel to turn off faucet
When to Wash Your Hands
• When entering or leaving a patient room• When hands are visibly dirty• Before you eat• Before you prepare food items• After contact with any body fluids like blood, urine or vomit• After changing infant or adult diapers• After touching animals and pets• After using the restroom• After removing medical gloves
6 | P a g e C l i n i c a l E d u c a t i o n , P r a c t i c e a n d I n f o r m a t i c s - A c a d e m i c P l a c e m e n t 2020
Confidentiality Agreement
AGREEMENT
In my job, I may see or hear confidential information in any form (oral, written, or electronic) regarding:
- HEALTH PLAN MEMBERS AND PATIENTS AND/OR THEIR FAMILY MEMBERS (such as patient records, testresults, conversations, financial information)
- EMPLOYEES, PHYSICIANS, VOLUNTEERS, CONTRACTORS (such as employment records, correctiveactions/disciplinary actions)
- BUSINESS INFORMATION (such as member rates, marketing plans, financial projections)
I will protect the confidentiality of this information. Access to this information is allowed only if I need to know it to do my job.
I AGREE THAT:
1. I will protect the privacy of our patients, members, and employees.2. I will not misuse confidential information of patients, members, employees or Kaiser Permanente (including confidential
business and personnel information) and I will only access information I have been instructed or authorized to access to do my job. With respect to Protected Health Information, I will only access or use such information as it is necessary to provide medical care to the member and/or patient or as necessary for billing and payment or health plan operations.
3. I will not access my family members' PHI. I will not access my own medical records unless my job duties authorize me to have access to electronic medical records (for example, KP HealthConnect). Instead, I will follow the same procedures that apply to non-employee health plan members.
4. I will not share, change, remove or destroy any confidential information unless it is part of my job to do so. If any of these tasks are part of my job, I will follow the correct department procedure or the instructions of my supervisor/chief of service (such as shredding confidential paper). If a demand is made upon me from outside Kaiser Permanente to disclose confidential information, I will obtain approval from my supervisor before disclosing such information.
5. I understand that inappropriate or unauthorized access, use or disclosure of PHI may result in legally required reporting to governmental authorities, including my name.
6. I know that confidential information I learn on the job does not belong to me and that Kaiser Permanente may take away my access to confidential information at any time.
7. If I have access to electronic equipment and/or records, I will keep my computer password secret and I will not share it with any unauthorized individual. I am responsible if I fail to protect my password or other means of accessing confidential information.
8. I will not use anyone elses password to access any Kaiser Permanente system unless I am authorized to do so. If I am authorized to do so (e.g., in order to perform computer systems maintenance), I will follow procedures to ensure the password is changed and that confidential information is not at risk.
9. I will lock my computer when I step away to prevent someone else accessing the computer under my logon. I understand that I am personally responsible for any accesses under my logon.
10. If I leave Kaiser Permanente I will not share any confidential information that I learned or had access to during my employment.
11. On termination of my employment, I will promptly return to Kaiser Permanente all originals and copies of documents containing Kaiser Permanente's information or data in my possession or control, unless the documents were provided to me as part of my employment record.
Confidentiality Agreement
Examples of Breaches of Confidentiality (What you should NOT do.)
These are examples only and do not include all possible breaches of confidentiality.
- Unauthorized reading of patient account information.- Unauthorized reading of a patient's chart.- Unauthorized access to my own medical information if my job duties do not authorize me to have access to electronic
medical records (for example, KP HealthConnect).- Accessing medical information of friends, co-workers, family members, or anyone else, unless it is required for my job.- Discussing confidential information in a public area such as a waiting room or elevator.- Discussing or otherwise sharing confidential information with anyone in your personal life, including family members or
friends.- Accessing records for any reason other than for legitimate business purpose.- Accessing records of family, friends, co-workers, patients in the media, well known political figures, celebrities, or
anyone else about whom you are curious.- Sending confidential information to your personal e-mail account, unless you are authorized to do so and the
information is transmitted in accordance with required procedures (e.g., encrypted).- Saving confidential electronic information to a KP-owned or non-KP-owned flash drive, CD, or any other removable or
transportable storage device unless you first secure permission as outlined in the Secure Electronic Storage provisionsof the KP Information Security Policy.
- Saving confidential electronic information to a KP-owned or non-KP-owned workstation, laptop computer, personaldigital assistant, or any other mobile computing device unless you first secure permission as outlined in the SecureElectronic Storage provisions of the KP Information Security Policy.
- Using personal devices (digital cameras, camera phones) to take photographs that may include confidentialinformation as the primary subject or in the background.
- Documenting or referencing confidential information on any social networking site, such as Twitter, My Space.- Telling a co-worker your password so that he or she can login to your work.- Telling an unauthorized person the access codes for employee files or patient accounts.- Being away from your workstation while you are logged into an application, without locking your system to protect
confidential information.- Unauthorized use of a co-worker's password to logon to a Kaiser Permanente information system.- Unauthorized use of a user ID to access employee files or patient accounts.- Allowing a co-worker to use your secured application* for which he/she does not have access after you have logged in.
* secured application = any computer program that allows access to confidential information. A secured applicationusually requires a user name and password to log in.
12. I understand that I am responsible for my access, use, or misuse of confidential information and know that my accessto confidential information may be audited.
13. I understand that my supervisor/chief of service or other managers and/or the Compliance Hot Line are available if Ithink someone is misusing confidential information or is misusing my password. I further understand that KaiserPermanente will not tolerate any retaliation because I make such a report.
14. I understand that patient privacy and security is included in various training programs within Kaiser Permanente (forexample: New Employee training, Annual Compliance Training), and by taking such training, I understand theobligations of confidentiality. I further understand that it is my responsibility to secure guidance from my supervisor ormanager in the event any questions exist relating to my obligations regarding confidentiality.
15. I understand that this policy is not meant to prohibit any protected rights provided for in the National Labor RelationsAct (for represented employees).
Confidentiality Agreement 16. I understand that failure to comply with this agreement may result in disciplinary action up to and including termination
of employment or other relationship with Kaiser Permanente. I understand that I may also be subject to other remediesallowed by law.
17. I understand that I must also comply with any laws, regulations, and other Kaiser Permanente policies, including thePrinciples of Responsibility that address confidentiality.
I agree that I have read, understand, and that I will comply with this Confidentiality Agreement.
________________________________ _____________ STUDENT/TRAVELER SIGNATURE DATE
___________________________________ FACILITY/DEPARTMENT
Child Abuse Reporting Requirements
REQUIREMENTS
Section 11166 of the Penal Code requires any child care custodian, health practitioner, or employee of a child protective agency who has knowledge of or observes a child in his or her professional capacity or within the scope of his or her employment who he or she knows or reasonable suspects has been the victim of child abuse or who he or she knows or reasonably suspects that a child is suffering serious emotional damage or is at substantial risk of suffering serious emotional damage to report the known or suspected instance of child abuse to a child protective agency immediately or as soon as practically possible by telephone and to prepare and send a written report thereof within 36 hours of receiving the information concerning the incident.
The identify of all persons who report shall be confidential and disclosed among agencies receiving or investigating mandated reports, to the district attorney in a criminal prosecution, or in an action initiated under Section 602 of the Welfare and Institutions Code arising from alleged child abuse, or to counsel appointed pursuant to subdivision (c) of Section 317 of the Welfare and Institutions Code, or to the county counsel or district attorney in a proceeding under Part 4 (commencing with Section 7800) of Division 12 of the Family Code or Section 300 of the Welfare and Institutions Code, or to a licensing agency when abuse or neglect in out-of-home care is reasonably suspected, or when those persons waive confidentiality, or by court order.
“Health practitioner” include physicians and surgeons, psychiatrists, dentists, residents, interns, podiatrists, chiropractors, licensed nurses, dental hygienists, optometrists, or any other person who is licensed under Division 2 (commencing with Section 500) of the Business and professions Code; marriage, family and child counselors, emergency medical technicians I or II, paramedics, or other person certified pursuant to Division 2.5 (commencing with Section 1797) of the Health and Safety Code; psychological assistants registered pursuant to Section 2913 of the Business and Professions Code; state or county public health employees who treat minors for venereal disease or any other condition; coroners; paramedics; and religious practitioners who diagnose, examine, or treat children.
Volunteers whose duties include direct contact with and supervision of children and not mandated reporters, but are encouraged to report instances of child abuse and neglect.
Your department chief or supervisor should be notified whenever you believe you may be required to report suspected child abuse.
I understand and agree, if in a Child Care Custodian or Health Practitioner classification, as defined above, to comply fully with the above-cited provisions of the California Penal Code, in accord with procedures established by my Employer/Medical Center.
_________________________________ ___________ STUDENT/TRAVELER SIGNATURE DATE
____________________________________ FACILITY/DEPARTMENT
Domestic Violence Reporting Requirements
Domestic Violence: Any stated threat or infliction against an adult or adolescent, intimate partner, past or present, by means of physical violence, threats, emotional abuse, harassment, or stalking that is directed at achieving compliance from or control over the victim.
California State law (health and Safety Code section 1259.5) requires that a care provider knows how to identify and handle patients whose injuries or illnesses are attributed to domestic violence.
Victims of domestic violence may try to hide the abuse. Abuse may start or increase during pregnancy.
Be alert to: Behavioral Cues - nervous, inappropriate laughter, lack of eye contact, minimizing serious injuries- overly attentive, hovering partner- frequent user of health care services, especially for psycho-somatic complaints
Physical Indicators - central distribution of injuries- face, throat, neck, chest, abdomen, breasts, genitals- delay between onset of injury and presentation for treatment- multiple injuries in various stages of healing
Under California Penal Code, Section 11160, suspected domestic violence must be reported. Failure to report such abuse is a misdemeanor and punishable by a fine of $1000.00 and / or jail term of six months.
It is a care provider’s responsibility to report when a patient seeks medical treatment when injuries have been inflicted upon them, regardless of the patient’s wish to self-report.
1. Oral report must be made as soon as possible.
2. Written report must be competed and sent within 48 hours to a law enforcement agency where incidentoccurred. Reports may be faxed to reporting agency.
Documentation Responsibilities as a Healthcare Provider: Remember that the reporting form is not a substitute for complete documentation.
Refer to your local KP Administrative policy titled: Abuse – Assessment, Management and Reporting Child, Elder/Dependent Adult and Domestic Violence Policy for detailed description of suspected abuse signs and symptoms, treatment, reporting, documentation, and web sites available to learn more about abuse.
Elder & Dependent Abuse Reporting Requirements
California Welfare and Institutions (W&I) Code Section 15659 requires Kaiser Permanente Medical program to provide all “health professionals” and “care custodians” information concerning their responsibility to report incident of observed, known, or suspected elder and dependent abuse. All health practitioners or care custodians must sign a statement acknowledging receipt and understand of the mandatory elder and dependent abuse reporting requirements. Kaiser Permanente must retain the signed statement.
Elders are persons 65 years of age or older. Dependent adults are persons between the ages of 18 and 64 with physical or mental limitations such as physical or developmental disabilities or age-diminished physical or mental abilities. The law also expressly includes any person between the ages of 18 and 64 who is admitted as an inpatient to an acute care hospital or other 24-hour facility as a dependent adult (W&I Code Sections 15610.23, 15610.27 and 15701.2).
Abuse of and elder or dependent adult means either of the following:
(a) Physical abuse, including lewd or lascivious acts, neglect, financial abuse, abandonment, isolation,abduction, or other treatment with resulting physical harm or pain or mental suffering; or
(b) The deprivation by a care custodian of goods or services that are necessary to avoid physical harm ormental suffering (W&I Code Section 15610.07).
At Kaiser Permanente, a physician, nurse, and licensed or unlicensed health care professional, including administrative and support staff, who, in his or her professional capacity, or within the scope of his or her employment, has observed or has knowledge of elder and/or dependent abuse, or reasonably suspects elder and/or dependent abuse, shall report by telephone immediately or as soon as practically possible and by written report within two (2) working days as follows:
(a) to the long-term care ombudsmen or the local law enforcement agency when the abuse is alleged to haveoccurred in a long-term care facility;
(b) to the State Department of Mental Health, the State Department of Developmental Services, or the local lawenforcement agency if the abuse is alleged to have occurred in a state mental health hospital or statedevelopmental center; or
(c) To the adult protective services agency or the local law enforcement agency when the abuse is alleged tohave occurred anywhere else (W&I Code Section 15630).
All incidents should be documented and forwarded to the appropriate agency in accordance with local medical center procedures.
I certify that I have read and understand this statement and will comply with the requirements of the Elder and Dependent Abuse Reporting Law.
___________________________________________ _____________ STUDENT/TRAVELER SIGNATURE DATE
___________________________________________ FACILITY/DEPARTMENT
Kaiser Health Plan Member Rights and Responsibilities & Kaiser Hospital Patient Rights and Responsibilities
KAISER PERMANENTE respects the rights of members and recognizes that each member is an individual with unique health care needs and (because of the importance of respecting each member’s personal dignity) provides considerate, respectful care focused upon the member’s individual needs.
It is the responsibility of every member of the health care team to assure that each health plan member or surrogate decision maker has the opportunity to exercise their rights in accordance with the California Administrative Code. Furthermore, Kaiser Permanente recognizes the responsibility to inform and educate staff to ensure that this policy is adhered to. Also, it is the responsibility of every member to make their needs and wishes known.
All personnel shall observe these member rights.
A. KAISER PERMANENTE MEMBER RIGHTS AND RESPONSIBILITIES
A member is defined as a Kaiser Permanente health plan member
Kaiser Permanente is committed to treating members in a manner that respects their rights and informs them of their rights and responsibilities as follows:
1. Members have a right to: Receive information about Kaiser Permanente, its services, its practitioners and providers, and
members’ rights and responsibilities. Be treated with respect and recognition of their dignity and right to privacy. Participate with practitioners in decision making regarding their health care. A candid discussion of appropriate or medically necessary treatment options for their conditions,
regardless of cost or benefit coverage. Voice complaints or appeals about Kaiser Permanente or the care provided.
2. Members have a responsibility to: Provide, to the extent possible, information that the managed care organization and its practitioners
and providers need in order to care for them. Follow the plans and instructions for care that they have agreed on with their practitioners. Keep appointments and when unable to do so for any reason, notify the responsible medical care
provider or the medical offices. Accept ownership for their actions if they refuse treatment or do not follow the medical care providers
instructions. Assure financial obligations for their health care treatment are fulfilled as promptly as possible.
AMBULATORY:
Kaiser Health Plan Member Rights and Responsibilities & Kaiser Hospital Patient Rights and Responsibilities
Provide accurate and complete information about present complaints, past illnesses, hospitalization,medications, and other matters relating to their health.
Report unexpected changes in their conditions to the medical care provider. Report whether he/she clearly comprehends a contemplated course of action and what is expected.
3. Kaiser Permanente assures members of their right to voice complaints and appeals. Questions orconcerns may be directed to the Patient Relations/Health Plan Office (s).
Members can also voice concerns by calling the Department of Corporations act 1-800-400-0615.
KAISER PERMANENTE respects the rights of patients and recognizes that each patient is an individual with unique health care needs and (because of the importance of respecting each patient’s personal dignity) provides considerate, respectful care focused upon the patient’s individual needs.
It is the responsibility of every member of the health care team to assure that each patient or surrogate decision maker has the opportunity to exercise their rights in accordance with the California Administrative Code. Furthermore, Kaiser Permanente recognizes the responsibility to inform and educate staff to ensure that this policy is adhered to. Also, it is the responsibility of every patient to make their needs and wishes known.
Therefore, every patient receives a written statement of these rights.
All hospital personnel shall observe these patient rights.
B. KAISER PERMANENTE MEDICAL CENTER PATIENT RIGHTS AND RESPONSIBILITIES
A patient is defined as a person who is seen in the Emergency Department and/or is hospitalized as an inpatient or outpatient at the Kaiser Permanente Medical Center.
Patients have the right to: 1. Exercise these rights without regard to sex; cultural, economic, educational, or religious background; or the
source of payment for care.2. Considerate and respectful care.3. Knowledge of the name of the physician who has primary responsibility for coordinating the care and the names
and professional relationships of other physicians and non-physicians who will see the patient.4. Receive information from the physician about the illness, the course of treatment, and the prospects for
recovery in the terms that the patient can understand.5. Receive as much information about any proposed treatment or procedure as the patient may need in order to
give informed consent or to refuse this course of treatment. Except in emergencies, this information shall include a description of the procedure or the treatment, the medically significant risks involved in this treatment,
HOSPITAL:
Kaiser Health Plan Member Rights and Responsibilities & Kaiser Hospital Patient Rights and Responsibilities
alternate courses of treatment or non-treatment, and the risks involved in each, and to know the name of the person who will carry out the procedure or treatment.
6. Participate actively in decisions regarding the patient’s medical care. To the extent permitted by law, thisincludes the right: To refuse treatment To be involved in all aspects of their care To be involved in resolving dilemmas about care decisions To have their family participate in care decisions as appropriate
Note: Minors capable of participating in decisions regarding their medical care shall be involved in decision making, along with their parents or guardians. 7. Have the hospital demonstrate respect for the following patient needs:
a. Full consideration of privacy concerning the medical care program. Case discussion, consultation,examination, and treatment are confidential and should be conducted discreetly. The patient has the rightto be advised as to the reason for the presence of any individual.
b. Confidential treatment of all communications and records pertaining to the patient’s care and stay inhospital. Written permission shall be obtained before the medical records can be made available toanyone not directly concerned with the care.
c. Security and hospital support of the patient’s right to access protective services.d. Communication.e. Pastoral counseling.
8. Reasonable responses to any reasonable requests made for service. The patient’s right to treatment or serviceis respected and supported.
9. Leave the hospital, even against the advice of physicians.10. Reasonable continuity of care and to know in advance the time and location of appointments as well as persons
providing the care.11. Be advised if hospital/personal physician proposes to engage in or perform human experimentation affecting
care or treatment. The patient has the right to refuse to participate in such research projects. All patientsasked to participate in a research project are: Given a description of the expected benefits Given a description of the potential discomforts and risks Given a description of the alternative services that might also prove advantageous to them Given a full explanation of the procedures to be followed, especially those that are experimental in nature Told that they may refuse to participate, and that their refusal will not compromise their access to services
12. Be informed of continuing health care requirements following discharge from the hospital.13. Examine and receive an explanation of the bill regardless of source of payment.
Kaiser Health Plan Member Rights and Responsibilities & Kaiser Hospital Patient Rights and Responsibilities
14. Know which hospital rules and policies apply to the patient’s conduct while a patient.15. Have all patients’ rights apply to the person who may have legal responsibility to make decisions regarding
medical care on behalf of the patient.16. Have visitors as described below:
a. Designate visitors of his/her choosing, if the patient has decision making capacity, whether or not thevisitor is related by blood or marriage, unless: No visitors are allowed The facility reasonably determines that the presence of a particular visitor would endanger the health
and safety of a patient, a member of the health facility staff, or other visitor to the health facility, orwould significantly disrupt the operations of the facility.
The patient has indicated to the health facility staff that the patient no longer wants the person to visitb. Have the patient’s wishes considered for purposes of determining who may visit if the patient lacks
decision making capacity and to have the method of that consideration disclosed in the hospital policy onvisitation. At a minimum, the hospital shall include any person living in the household.
c. When restrictions are placed on a patient's visitors, mail, telephone calls, or other forms of communication,the restrictions are evaluated for therapeutic effectiveness.
d. Any restrictions on communication are fully explained to the patient and family and are determined withtheir participation.
Note: The above information on visitors may not be construed to prohibit Kaiser Permanente from otherwise establishing reasonable restrictions upon visitation, including restrictions upon the hours of visitation and number of visitors.
Patients have the responsibility to: 1. Follow hospital rules and regulations affecting care and conduct.2. Be considerate of the rights of other patients and of the hospital personnel.3. Assist in the control of noise, smoking, and a number of visitors.4. Be respectful of the property of other persons and of the hospital.
Patient complaints may be forwarded to the hospital administration for appropriate response as follows: Questions or concerns may be directed to the Patient Relations Office
Staff Rights
Kaiser Permanente (KP) California Human Resources Policy 2.03 clarifies your right as a caregiver to request to refrain from participation in aspects of patient care or treatment due to moral, ethical, or religious beliefs. KP will reasonably accommodate a caregiver’s moral, ethical or religious beliefs as long as they do not negatively affect patient care, safety, or treatment or cause undue hardship to KP.
If you feel this applies to you, you must notify your manager prior to the denial of service. A form to request accommodation(s) is attached. Your manager will discuss possible accommodations with you, which may include (but are not limited to):
1. Revised procedures;
2. Job restructuring which permits you to perform the essential functions of the job and which do notnegatively affect patient care, safety, or treatment or cause undue hardship to KP;
3. Reassignment to a similar, vacant position in accordance with any applicable collective bargainingagreement or policy.
KP will make the final determination as to what, if any, accommodation(s) will be provided and how aspects of patient care will be performed. Further, in emergency situations in which the immediate nature of a patient’s need will not allow for substitution, the patient’s right to receive necessary care takes precedence over the exercise of the caregiver’s individual moral, ethical, or religious beliefs.
I have read the above information and am aware of the outlets available to me should I encounter a conflict with my personal ethics, religious beliefs, or cultural values while on the job.
___________________________________________ ____________ STUDENT/TRAVELER SIGNATURE DATE
_______________________________________________ FACILITY/DEPARTMENT
7 | P a g e C l i n i c a l E d u c a t i o n , P r a c t i c e a n d I n f o r m a t i c s - A c a d e m i c P l a c e m e n t 2020
UNIT ORIENTATION CHECKLIST
NAME LAST, FIRST: _______________________________ DEPARTMENT ASSIGNED TO: ______________________
SCHOOL: ______________________________ INITIAL WHEN COMPLETED: __________
______INTRODUCTIONS TO STAFF -- HOW TO CONTACT SUPERVISOR/PHYSICIANS • work assignments, daily routine • Kaiser employee who is their resource• breaks (lunch/coffee)• department tour
______DEPARTMENT LIFE SAFETY • location of fire alarm, fire extinguishers• evacuation routes/map of where to meet• responding to a fire – R= relocate staff/patients, A = activate the alarm, C = confine/ contain the fire, E = extinguish
_______DEPARTMENT DISASTER PLAN • department disaster plan/manual• review of disaster codes
_______DEPARTMENT HAZARDOUS MATERIALS • location of hazardous materials information – MSDS binder (Material Safety Data Sheets)/Intranet resources• safe storage/utilization of materials• safe clean-up of materials• spill clean-up (X14949 facility services @ Homestead)
_______INFECTION CONTROL PRACTICES • proper hand washing-hand hygiene• use of personal protective equipment• knowledge of universal precautions/bloodborne pathogens/manual
_______GENERAL SAFETY • report unsafe hazards to manager/Kaiser staff• report injuries to yourself to manager/Kaiser staff• knowledge of emergency codes• policy and procedure manual and any other resource manuals pertinent to the unit• HIPAA
______OTHER RESOURCE MANUALS/INTRANET TOUR
______ CONFIDENTIALITY/PATIENT PRIVACY I have received the required information:
Student Signature: ________________________________ Date: ___________________________
Unit orientation given by: ________________________ Job Title:___________________ Date:____________
