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Requirement Explanation

Package Name Category Name Student Notes URL Item Name Field Name New Students Compliance Package 1

Physical Examination Form

You must submit your physical examination form. http://chamberlainclinical compliance.com/forms/CC N_PhysicalExaminationFor m.pdf, http://chamberlainclinical compliance.com/forms/Ch amberlainJobAidStudentR esourceUpdate.pdf

Competencies and Functional Abilities

Date

Document

Health History and Physical

Document

Date

Student Medical Clearance Authorization

Date

Document

Physical Examination Form

Document

Date

Virtual Compliance Orientation

1. Click on the link +Enter Requirement in the Virtual Orientation Category. 2. Click on the link to the Orientation and view video. 3. Answer questions related to the video. 4. Once you have completed all questions you will automatically be approved for this Category

https://www.brainshark.c om/devry/VirtualComplian ceOrientation, http://chamberlainclinical compliance.com/forms/Ch amberlainJobAidStudentR esourceUpdate.pdf

Virtual Compliance Orientation

Date

Document

Virtual Compliance Orientation Quiz

1. Why is program compliance important? 2. If submitting titers, documents must include date, result and reference range. If no reference range is available, “immune” or “non-immune” must be indicated on document 3. Titer must be IgG (antibody) titers, not IgM (antigen) 4. What is your compliance deadline for items that you have expiring during the July session? 5. Once you upload and enter requirements from compliance documentation, how long does it typically take for the item to be reviewed and a status determined? 6. If the status of an uploaded document changes to “Does Not Meet Requirements,” students should take the following steps

700 17th Street, 10th Floor, Denver, CO 80202 Phone: 303-573-1130 Fax: 303-573-1779 American DataBank

New Students Compliance Package 1

Seasonal Flu Vaccine Must submit Flu vaccine from the current flu season.

Vaccines administered on or after August 1st will remain valid and compliant until October 1st of the following year.

http://chamberlainclinical compliance.com/forms/Se asonalFluVaccineBSN.pdf, http://chamberlainclinical compliance.com/forms/Ch amberlainJobAidStudentR esourceUpdate.pdf

Seasonal Flu Vaccine Date Administered

Document

Expiration Date

Facility that Administered the Vaccine Manufacturer Lot#

Manufacturer/Trade Name Vaccine Expiration Date City of the Facility that Administered the Vaccine

Tuberculosis You must submit proof of one of the following groups of items (1, 2, 3, or 4):

1. Proof of a negative Two- Step PPD (dated 1 week to 3 months apart).

a. Annually after, you will be required to submit proof a negative Annual PPD, negative QuantiFERON Gold Test or negative T-Spot.

2. Proof of a negative QuantiFeron Gold Test. a. Annually after, you will be required to submit proof a negative Annual PPD, negative QuantiFERON Gold Test or negative T-Spot.

3. Proof of a negative T-Spot. a. Annually after, you will be required to submit proof a negative Annual PPD, negative QuantiFERON Gold Test or negative T-Spot. 4. Proof of a negative Chest X-Ray. a. Annually after, you will be required to submit a TB Clearance Note or TB Questionnaire.

http://chamberlainclinical compliance.com/forms/CC N_TB.pdf, http://chamberlainclinical compliance.com/forms/CC N_AnnualTB.pdf, http://www.chamberlaincl inicalcompliance.com/for ms/TBScreenForm.pdf, http://chamberlainclinical compliance.com/forms/Ch amberlainJobAidStudentR esourceUpdate.pdf

PPD 1 Date Administered

Read Date

Document

Results

PPD 2 Date Administered

Read Date

Document

Results

Next TB Screening Due

Annual Tuberculosis Screening

Date Administered

Testing Type

Read Date

Document

Expiration Date

Results

Due Date

Initial IGRA Document

Results

Next TB Screening Due

Date

Chest X-Ray Document

Expiration Date

Results

TB Clearance Note or TB Questionnaire Due Date

700 17th Street, 10th Floor, Denver, CO 80202 Phone: 303-573-1130 Fax: 303-573-1779 American DataBank

New Students Compliance Package 1

Tuberculosis You must submit proof of one of the following groups of items (1, 2, 3, or 4):

1. Proof of a negative Two- Step PPD (dated 1 week to 3 months apart).

a. Annually after, you will be required to submit proof a negative Annual PPD, negative QuantiFERON Gold Test or negative T-Spot.

2. Proof of a negative QuantiFeron Gold Test. a. Annually after, you will be required to submit proof a negative Annual PPD, negative QuantiFERON Gold Test or negative T-Spot.

Chest X-Ray Chest X-Ray Due Date

Date

TB Clearance Note or TB Questionnaire

Document

Expiration Date

Due Date

Date

MMR You must submit proof of one of the following groups of items:

MMR

• Proof of MMR Immunization (2 doses/minimum 28 days apart) When submitting MMR Doses or Post titer vaccinations you will be temporarily compliant for a period of time MMR1 (28 days) MMR 2

• MMR Titer with positive/immune results (Measles, Mumps, Rubella Titer)

If ANY of your Titers are not immune (negative or equivocal) then you must submit proof of the following: • Proof of Post Titer MMR series: you must submit two post Titer vaccinations.

http://chamberlainclinical compliance.com/forms/Ch amberlainJobAidStudentR esourceUpdate.pdf

Measles Titer Document

Results

Today's Date

Date

Mumps Titer Document

Results

Today's Date

Date

Rubella Titer Document

Results

Today's Date

Date

MMR 1 Document

Date Administered

MMR 2 Document

Date Administered

Post-Titer MMR Adult Booster 1

Document

Date Administered

Post-Titer MMR Adult Booster 2

Document

Date Administered

700 17th Street, 10th Floor, Denver, CO 80202 Phone: 303-573-1130 Fax: 303-573-1779 American DataBank

New Students Compliance Package 1

Varicella

You must submit proof of one of the following groups of items (1 or 2): Varicella • Proof of Varicella (Chickenpox) Immunization (2 doses/minimum 28 days apart) When submitting Varicella Doses or Post titer vaccines you will be temporarily compliant for a period of time: Varicella Dose 1 (28 days) Varicella Dose 2.

• Varicella Titer with positive/immune results If Titer is not immune (negative or equivocal) then you must submit proof of the following: • Proof of Post Titer Varicella series you must submit two post Titer vaccinations.

http://chamberlainclinical compliance.com/forms/Ch amberlainJobAidStudentR esourceUpdate.pdf

Varicella Titer Document

Results

Date

Varicella Dose 1 Document

Date

Varicella Dose 2 Document

Date

Post-Titer Varicella Adult Booster 1

Document

Date

Post-Titer Varicella Adult Booster 2

Document

Date

Hepatitis B

You must submit proof of one of the following groups of items (1 or 2): Hepatitis B Proof of Hepatitis B series (3 doses): – Dose 1 – Dose 2 (30 days from Dose 1) – Dose 3 (5 months from Dose 2) Or • Proof of Heplisav-B®, (HepB-CpG) Vaccine (2 Doses)*: – Dose 1 – Dose 2 (30 days from Dose 1) When submitting a Hepatitis B 3 shot or 2 shot series or Repeat series, you will show temporarily compliant for a period of time between shots (30 days between Dose 1 and Dose 2, and 5 months between Dose 3)

• Hepatitis B Titer with positive/immune results If Titer is not immune (negative or equivocal) then you must submit proof of the following: • Submit proof of the following: 3 dose repeat series or 2 dose repeat series vaccinations dated AFTER the not immune titer.

http://chamberlainclinical compliance.com/forms/Ch amberlainJobAidStudentR esourceUpdate.pdf

Hepatitis B HBsAB Titer Document

Results

Date

Hepatitis B Series Dose 1 Document

Date

Hepatitis B Series Dose 2 Document

Date

Hepatitis B Series Dose 3 Document

Date

Repeat Hepatitis B Series Dose 1

Document

Date

Repeat Hepatitis B Series Dose 2

Document

Date

Repeat Hepatitis B Series Dose 3

Document

Date

Hepatitis B 2 Dose Series Dose 1 (Heplisav)

Document

Date

Hepatitis B 2 Dose Series Dose 2 (Heplisav)

Document

Date

Repeat Hepatitis B 2 Dose Series Dose 1 (Heplisav)

Document

Date

Repeat Hepatitis B 2 Dose Series Dose 2 (Heplisav)

Document

Date

700 17th Street, 10th Floor, Denver, CO 80202 Phone: 303-573-1130 Fax: 303-573-1779 American DataBank

New Students Compliance Package 1

TDAP You must submit proof of an Initial Tdap. Once that Tdap is 10 years old, you must submit a Tdap, dTap, or Td Booster.

http://chamberlainclinical compliance.com/forms/Ch amberlainJobAidStudentR esourceUpdate.pdf

Initial Tdap Document

Next Shot Due

Date

Tdap/dTap/Td Booster Document

Expiration Date

Due Date

Date

Student Commitment to Clinical Behaviors

E-sign forms in Complio http://chamberlainclinical compliance.com/forms/St udentCommitmentToClinic alBehaviorsBSN.pdf, http://chamberlainclinical compliance.com/forms/Ch amberlainJobAidStudentR esourceUpdate.pdf

Student Commitment to Clinical Behaviors (Paper)

Date

Document

Student Commitment to Clinical Behaviors

Date

Complete Form

Letter of Understanding/Confide ntiality Statement

E-sign forms in Complio http://chamberlainclinical compliance.com/forms/Pe rsonalHC_ResponsLetterC onfidStatement_HCCUpda te.pdf, http://chamberlainclinical compliance.com/forms/Jo bAidStudentResource.pdf

Letter of Understanding/Confident iality Statement

Date

Document

Age 18+ Letter of Understanding/Confident iality Statement

Date

Complete Form

Under age 18 Letter of Understanding/Confident iality Statement

Date

Document

HIPAA Certification 1. You must click the + Enter Requirement link under the category HIPAA and OSHA. 2. Complete the Review. 3. Take the Quiz. 4. Correct any incorrect answers. 5.Once you have completed and passed the Quiz you will be automatically approved for the category.

http://chamberlainclinical compliance.com/forms/CC N_HIPAA.pdf, http://chamberlainclinical compliance.com/forms/Ch amberlainJobAidStudentR esourceUpdate.pdf

HIPAA Certification Document

Expiration Date

Date Passed

Due Date

HIPAA Quiz Expiration Date

Due Date

1. If the patient is present and has the capacity to make health care decisions, when does HIPAA allow a health care provider to discuss the patient’s health information with the patient’s family, friends, or others involved in the patient’s care or payment for care?

700 17th Street, 10th Floor, Denver, CO 80202 Phone: 303-573-1130 Fax: 303-573-1779 American DataBank

New Students Compliance Package 1

http://chamberlainclinical compliance.com/forms/CC N_HIPAA.pdf, http://chamberlainclinical compliance.com/forms/Ch amberlainJobAidStudentR esourceUpdate.pdf

HIPAA Quiz 2. True or False: A doctor may give information about a patient’s mobility limitations to the patient’s sister who is driving the patient home from the hospital. 3. True or False: If the patient is not present or is incapacitated, a health care provider may not share the patient’s health information with family, friends, or others involved in the patient’s care or payment for care. 4. True or False: A health care provider may give information regarding a patient’s drug dosage to the patient’s health aide who calls the provider with questions about the particular prescription. 5. Does HIPAA require that a health care provider document a patient’s decision to allow the provider to share his or her health information with a family member, friend, or other person involved in the patient’s care or payment for care? 6. True or False: A health care provider may discuss a patient’s health information over the phone with the patient’s family, friends, or others involved in the patient’s care or payment for care without proof of who the person is?

700 17th Street, 10th Floor, Denver, CO 80202 Phone: 303-573-1130 Fax: 303-573-1779 American DataBank

New Students Compliance Package 1

http://chamberlainclinical compliance.com/forms/CC N_HIPAA.pdf, http://chamberlainclinical compliance.com/forms/Ch amberlainJobAidStudentR esourceUpdate.pdf

HIPAA Quiz 7. If you receive a request from a trusted co-worker to share more PHI/PII than necessary to answer a question, what is your best response? 8. A hospital or physician practice is required to protect the privacy of health information in what form? 9. In situations where there is a breach of PHI, what is required by HIPAA? 10. Contrary to policy, an employee looks in the electronic medical record of a celebrity to determine the reason for the celebrity’s recent hospitalization. While dining in the cafeteria, the employee’s manager overhears the employee telling a co- worker about the celebrity. The BEST next step for the manager is to 11. Fill in the blank: If there is a PHI breach, patients must be notified in writing within __ days of the date that anyone in the organization became aware of the incident. 12. True or False: "Minimum necessary" means, when PHI is used, disclosed, or requested, reasonable efforts must be taken to determine how much information will be sufficient to serve the intended purpose. 13. Which of the following is a procedure that protects the confidentiality of patient information?

700 17th Street, 10th Floor, Denver, CO 80202 Phone: 303-573-1130 Fax: 303-573-1779 American DataBank

New Students Compliance Package 1

http://chamberlainclinical compliance.com/forms/CC N_HIPAA.pdf, http://chamberlainclinical compliance.com/forms/Ch amberlainJobAidStudentR esourceUpdate.pdf

HIPAA Quiz 14. True or False: Each healthcare agency and provider are required to give patients a clear written explanation of how a provider or plan will use, keep, and disclose information. 15. When can PHI be released to a non- health care agency, such as a life insurer or bank? 16. Which of the following are requirements under the HIPAA privacy regulations? 17. If you suspect a fellow employee of violating privacy policies, you should 18. Patients have a right to 19. Healthcare agencies must have policies that provide guidelines for 20. True or False: It is the duty of every healthcare provider and agency to protect the confidentiality and privacy of patient healthcare information. Date

OSHA Certification 1. You must click the + Enter Requirement link under the category HIPAA and OSHA. 2. Complete the Review. 3. Take the Quiz. 4. Correct any incorrect answers. 5.Once you have completed and passed the Quiz you will be automatically approved for the category.

http://chamberlainclinical compliance.com/forms/Ch amberlainJobAidStudentR esourceUpdate.pdf, http://chamberlainclinical compliance.com/forms/CC N_OSHA.pdf

OSHA Certification Document

Expiration Date

Date Passed

Due Date

OSHA Quiz Expiration Date

Due Date

1. Blood borne pathogens are disease causing organisms carried in human blood. 2. A person could have HIV and not have any symptoms for several years.

700 17th Street, 10th Floor, Denver, CO 80202 Phone: 303-573-1130 Fax: 303-573-1779 American DataBank

New Students Compliance Package 1

http://chamberlainclinical compliance.com/forms/Ch amberlainJobAidStudentR esourceUpdate.pdf, http://chamberlainclinical compliance.com/forms/CC N_OSHA.pdf

OSHA Quiz 3. Change in smell/taste and generalized itching are some of the symptoms of hepatitis. 4. A blood borne pathogen causes tuberculosis. 5. Needle sticks are the most common way that health care workers have contracted a blood borne pathogen disease while working. 6. Standard precautions do not apply to patients over 70 years. 7. There is very low risk of contracting Hepatitis C from a single needle stick. 8. A contaminated needle should be recapped. 9. All hospital personnel should be vaccinated for HIV. 10. Handwashing is the next step to follow after removing your gloves. 11. To prevent splash exposure to blood or body fluids, masks and goggles should always be worn together. 12. You must always think any patient is a possible carrier of blood borne pathogens. 13. Gloves can be worn from one patient to the next patient as long as they are not torn. 14. Blood contaminated paper towels can be discarded in the regular trash.

700 17th Street, 10th Floor, Denver, CO 80202 Phone: 303-573-1130 Fax: 303-573-1779 American DataBank

New Students Compliance Package 1

http://chamberlainclinical compliance.com/forms/Ch amberlainJobAidStudentR esourceUpdate.pdf, http://chamberlainclinical compliance.com/forms/CC N_OSHA.pdf

OSHA Quiz 15. A person with active TB will usually display signs/symptoms. 16. All hospital employees must have a PPD skin test or TB screening every year. 17. Sharing the same food spreads tuberculosis. 18. All employees who need to wear a N95 mask will have to be fit tested and receive special training. 19. The treatment for TB lasts for at least 6 months. 20. The best way to prevent the spread of TB is by early identification, proper isolation, and proper treatment. Date

CPR Certification Chamberlain only accepts and you must submit proof of American Heart Association or American Red Cross issued BLS card/e-card for Healthcare Providers • Temporary Compliance for 30 days proof of Course Completion – Proof current CPR course completion (both certificates must be included) OR – Letter of completion from the instructor

http://chamberlainclinical compliance.com/forms/Ch amberlainJobAidStudentR esourceUpdate.pdf

American Heart Association BLS for Healthcare Provider CPR Certification

Document

Expiration Date

Due Date

Date

CPR Waiver (DeVry) Date of Waiver

Document

MTN BLS Provider Document

Expiration Date

Due Date

Date

American Red Cross BLS Document

Expiration Date

Due Date

Date

700 17th Street, 10th Floor, Denver, CO 80202 Phone: 303-573-1130 Fax: 303-573-1779 American DataBank

New Students Compliance Package 1

Health Insurance Card You must submit proof of one of the following groups of items (1, 2, 3, or 4).

1. A copy of the front and back of your Health Insurance Card. 2. A letter from the VA 3. A copy of your DD-214 4. A copy of your Tricare Insurance If you choose to obtain the Chamberlain (Aetna) insurance, enrollment can be completed by visiting: https://www.aetnastudenthealth.com Once obtained, upload and map a copy of the Aetna enrollment form to your Complio profile.

http://chamberlainclinical compliance.com/forms/Ch amberlainJobAidStudentR esourceUpdate.pdf

Letter from VA Date

Document

Expiration Date

Due Date

Health Insurance Card Document

Expiration Date

Due Date

Date

Chamberlain (UHC) Enrollment Form

Document

Expiration Date

DD-214 Date

Document

Expiration Date

Due Date

Tricare Insurance Date

Document

Expiration Date

Due Date

Chamberlain (Aetna) Enrollment Form

Document

Expiration Date

FBI Fingerprints You must order fingerprints through American DataBank. Once you receive the results from the FBI, please upload these results.

http://chamberlainclinical compliance.com/forms/Ch amberlainJobAidStudentR esourceUpdate.pdf

Fingerprints - American DataBank

Document

Results

Date

Fingerprints - Other Document

Date

Chamberlain Disclosure - Fingerprint

Date

Is Disclosure Valid

700 17th Street, 10th Floor, Denver, CO 80202 Phone: 303-573-1130 Fax: 303-573-1779 American DataBank

New Students Compliance Package 1

COVID-19 You may submit your COVID-19 vaccine into this category. Your school will indicate if the category is required for you, and if a booster is required or not. If your school indicates a COVID-19 vaccine is required, you must submit two doses of Pfizer, Moderna, or Novavax, or one dose of Johnson & Johnson, one dose of the bivalent Pfizer or Moderna vaccine, or one dose of the update single dose Pfizer/Moderna vaccine from 09/11/23 or later.

To be approved as a bivalent vaccine, it must either state bivalent or have been received April 18th, 2023 or later. If your school indicates that a booster is also required, you must submit a booster once your second Pfizer, Moderna, or Novavax dose becomes five months old or once your Johnson & Johnson or bivalent Pfizer or Moderna dose becomes two months old.

This category is not required for compliance unless your school indicates that you must meet the requirement. If your school does so, you will lose compliance if you have not uploaded suitable vaccines.

https://www.chamberlain. edu/coronavirus

Require COVID-19 Vaccine

COVID-19 Dose 1 of 2 Document

Manufacturer

Date

COVID-19 Dose 2 of 2 Document

Manufacturer

Date

COVID-19 1 Dose Series (Johnson and Johnson)

Document

Manufacturer

Date

COVID-19 Booster Document

Manufacturer

Date

COVID-19 Bivalent Single Dose

Document

Manufacturer

Date

COVID-19 Pfizer/Moderna Single Dose

Date

Document

Manufacturer

Background Check You must complete a background check through American DataBank. Once complete, your results will be uploaded for you.

http://chamberlainclinical compliance.com/forms/Ch amberlainJobAidStudentR esourceUpdate.pdf

Background Check Document

Results

Date

Chamberlain Disclosure - Background

Is Disclosure Valid

Date

Drug Screen You must complete a drug screen through American DataBank. Once complete, your results will be uploaded for you

http://chamberlainclinical compliance.com/forms/Ch amberlainJobAidStudentR esourceUpdate.pdf

Drug Screen Document

Results

Date

Chamberlain Disclosure - Drug Screen

Is Disclosure Valid

Date

700 17th Street, 10th Floor, Denver, CO 80202 Phone: 303-573-1130 Fax: 303-573-1779 American DataBank