ALL students must complete and submit this new clinical form for COVID Assumption of Risk Form in class to your instructor the first week of classes.
Page 1 – please complete your personal info at the top, including the last 4 digits of your SSN and any RHS employment information (list dates and facility if applicable). Clinical details for “Clinical Learning Experience” leave blank, and add your name at the bottom.
Page 2 – please print/sign and date at the bottom.
Page 3 – Please initial by each line item, and print/sign and date at the bottom and be sure to include the last 4 digits of your SSN.
Page 4 – Please print/sign and date the confidentiality agreement.
COVID-19 Assumption of Risk form must also be completed and signed/dated. [COVID Form].
Please review the updated Nursing Program Policies here: (Nursing Program Policies)