Appendix A.: Allied Health Department 

Clinical Code of Conduct 

As a student in an allied health program, appropriate behavior and attitudes are expected while in the classroom, at the College, and in the clinical facilities. Clinical misconduct that endangers patient safety will not be tolerated and may result in immediate dismissal from the course and program. The student must not threaten the physical and/or psychological well-being of a patient, a patient’s family, an employee, faculty, or other student by his/her performance in the clinical area. If this occurs, the student may fail the course in which the student is currently enrolled or be removed from the program.

Students are held accountable for any real or potential threat to a patient, an employee, faculty or a student. A behavior or consistent behaviors that result in a threat to the patient’s, employee’s faculty’s or student’s physical and/or psychological behavior is termed “at risk” behavior. Examples of “at risk” behavior(s) include but are not limited to:

1. Violating principles learned in previous semesters. (e.g., a breach in aseptic technique)
2. Using or displaying inappropriate verbal or non-verbal behavior in the presence of the patient, the patient’s family, an employee, or faculty.
3. Violating HIPAA regulations regarding patient confidentiality and protected health information
4. Administering the wrong medication or wrong dosage.
5. Demonstrating lack of progress in performing required skills.
6. Criticizing patients, faculty, and/or staff.
7. Exceeding the absenteeism and/or punctuality policy established for clinical experience.
8. Communicating negative value judgments to patients and employees.
9. Demonstrating incompetence/lack of preparation for clinical assignment.
10. Practicing outside the legal and ethical framework of the profession.
11. Performing procedures prior to faculty/clinical staff approval.
12. Violating professional standard of practice. (e.g., integrity, respect)
13. Fabricating patient information in a patient’s medical record including forging signatures.
14. Stealing medication for personal use or for the benefit of others. 
15. Violating the sexual harassment policy as defined in the College’s Student Handbook with an employee of the clinical facility, College faculty and/or students.
16. One “at-risk” behavior may warrant immediate dismissal from the program if the behavior poses a serious threat to the physical and/or psychological well-being of patients, employees, faculty and students.

Procedure

1. “At-risk” behavior(s) will be documented on the appropriate form. The form must be completed to include all pertinent data stated clearly and the “at-risk” behavior(s) specifically identified.
2. If the faculty member or clinical coordinator is in doubt or if there are extenuating circumstances involved, the faculty member will meet with the clinical site supervisor and one additional faculty member to make a decision regarding the “at-risk” behavior.
3. A student and faculty conference will be held after the “at-risk” behavior has been documented to review the behavior, make recommendations, and obtain the student’s comments and signature.
4. A copy of the form will be given to the student, faculty member, clinical coordinator, clinical site supervisor and curriculum coordinator.
5. When a second “at-risk” behavior has been documented, the following procedures will be instituted:

• • The student will be counseled by the clinical coordinator, a faculty member and/or the curriculum coordinator regarding termination or removal from the currently enrolled course or program.
  • The student may withdraw by the designated withdrawal date from the course and receive a “W” for the course.
  • If the student is removed from the course and/or program by the curriculum coordinator, the student may appeal this decision to the department head and dean.

Note: Program director and curriculum coordinator are synonymous terms that can be used interchangeably in this document.

Clinical Code of Conduct Report Form 

Access the form here

Appendix B. Community College of Philadelphia MLT and Phlebotomy Programs Pregnancy Release Form and Documentation of Pregnancy

Access the form here

Appendix C. MEMORANDUM: Making a Complaint Student Complaint Form 

TO: Students in Allied Health Programs/Courses
FROM: Deborah Rossi
Department Head, Allied Health

The purpose of this memo is to provide the process for handling a concern or complaint in a course you are currently taking or have taken.  The recommended steps are as follows:

1. Inform your instructor immediately about any concern or problem you are having in the course.  It is important not to wait to address a concern.
2. You must make an appointment to meet with the instructor to discuss your concern.  Addressing a problem during classroom instruction is not appropriate or acceptable.
3. If after meeting with your instructor, you have not been able to resolve the issue with him/her, you may use the student complaint form.
4. You must complete the form in its entirety, providing all the requested information.
5. Upon completion of the form, submit it to me.  Upon receiving the form, I will contact you to acknowledge its receipt.  I will then make arrangements with you to meet with you and discuss the addressed complaint.  Documentation to support the concern/complaint will be requested.
6. Following our meeting, I will contact the faculty member and discuss the area(s) of concern with him/her.  I will request documentation from the instructor to try to determine whether or not the issue can be resolved with the information that has been made available to me.
7. If it appears that a meeting between the student, faculty member and department head is in the best interest to resolve the issue, a meeting will be arranged (within 10 days) to discuss the concerns.
8. Following the meeting, the student and faculty member will receive a letter from the department head, which identifies the outcome of her findings and expected resolutions, if any.
9. In the event that a student is in a select allied health program, the program director will be required to meet with the student prior to the department head meeting with the student.

Student Complaint Form

Access the form here

Appendix D. Infectious Agent and Bloodborne Pathogen Exposure Policy 

TBA

Appendix E.  Grading Policy and Evaluation forms

Clinical Site Information Form: 

Access the form here

Practicum Grading Policy  

Grade Quality	Description
Outstanding Distinction
A+  98-100	• Exceeds expectations. • Outstanding independent performance with no errors. • Made significant contributions to the laboratory environment. • Exceptional communication skills.
A 95-97	Outstanding independent performance. In-depth knowledge and understanding of principles and concepts related to the topic. Integrates information into a wider context. Limited errors with evidence of positive growth.
A- 93-94	• Excellent independent performance. • A comprehensive knowledge and understanding of principles and concepts. • Limited errors with evidence of positive growth.
Solid Accomplishment
B+ 90-92	• Very good independent performance. • A substantial but not totally comprehensive knowledge and understanding of principles and concepts. • Shows very good competence in the subject without being outstanding. • Few errors with evidence of positive growth.
B 87-89	Good independent performance.  A reasonable knowledge and understanding of principles and concepts. Shows very good competence in the subject without being outstanding. Few errors with evidence of positive growth.
B- 83-86	• Competent independent performance. • A reasonable knowledge and understanding of principles and concepts. •. Few errors with evidence of positive growth. Some gaps in knowledge.
Average. Adequate but Ordinary
C+ 81-82	• Satisfactory performance. Capable of work under minimal supervision after a period of time. • Limited VP skills. Frequent errors with minimal evidence of positive growth. • A basic knowledge of key principles and concepts only.
C 78-80	• Acceptable performance. Capable of independent work after a period of time. • Limited VP skills. Frequent errors with minimal evidence of positive growth. • Some significant gaps in knowledge.
C- 75-77	• Minimally acceptable performance. • Limited VP skills. Frequent errors with minimal evidence of positive growth. • Some significant gaps in knowledge and understanding. Standard, Mediocre, Just Passable
Poor Performance
D+ 71-74	• Weak performance. • Limited VP skills. Frequent errors with no evidence of positive growth. • Student is unable to correctly recall important information/material related to the practicum setting.
D 68-70	• Poor performance. • Limited VP skills. Frequent errors with no evidence of positive growth. • Student either has little knowledge of the subject area, or lacks the ability to express their knowledge in an organized fashion.
D- 65-67	• Poor performance. • Limited VP skills. Frequent errors with no evidence of positive growth. • Student has little knowledge of the subject area and lacks the ability to express their knowledge in an organized fashion.
Clear Failure
F <65	• The work is completely unsatisfactory and shows very little evidence of effort/interest. Student has difficulty grasping important functions and tasks in phlebotomy. Consistently performs with errors, demonstrates an unacceptable attitude, or both. • Little to no evidence of knowledge in the subject area.

Department policy for conversion of numerical grades to letter grades in Practicum Courses is listed below: For each of the components the grading scale is:

Letter Grade	Numeric Value	Letter Grade	Numeric Value	Letter Grade	Numeric Value	Letter Grade	Numeric Value
A+	98-100	B+	90-92	81-82	81-82	D+	71-74
A	95-97	B	87-89	78-80	78-80	D	68-70
A-	93-94	B-	83-86	75-77	75-77	D-	65-67
						F	<65

Computation of Final Grade

A separate percentage grade is calculated for each practicum course. Percentage grades for each evaluation component are: 

• Discipline Specific Competencies for Phlebotomy - 50% of the grade for the rotation.
• Evaluation of clinical performance and professionalism - 50% of the grade for the rotation.
• PHLEBOTOMY SPECIFIC SKILLS CHECK LIST –  Completion of all or at least 80% of all procedures is required on the Student Skills Check List (separate document): COMPLETE/INCOMPLETE
• Orientation form: COMPLETE/INCOMPLETE
• Attendance sheet (minimum 100 hours): COMPLETE/INCOMPLETE
• VP list – 100 VP should be documents with dates and initials of the trainer: COMPLETE/INCOMPLETE

A grade of incomplete will be recorded unless ALL practicum documentation is turned in at the completion of the practicum.

 The numeric Value component grades are then converted to letter grades.

Community College of Philadelphia MLT 102 Clinical Practice Summer 2019 Orientation form.

Access the form here

Phlebotomy Program Student Evaluation Forms MLT Phlebotomy 

Evaluation of Clinical Performance and Professionalism Form: Access the form here

MLT 102 Discipline Specific Competencies Phlebotomy Rotation Form

Access the form here

MLT 102 Phlebotomy Rotation Skill Check List

Access the form here

CCP PHLEBOTOMY PROGRAM MLT102 VENUPANTURE SHEET

Venipuncture Sheet: Access the form here

CCP Phlebotomy Program Student's Attendance Record

Attendance Record Form: Access the form here

ATTACHMENT F. ASCP exam Content guide

https://www.ascp.org/content/docs/default-source/boc-pdfs/boc-us-guidelines/pbt_ipbt_content_guideline.pdf?sfvrsn=4

Reading list:

https://www.ascp.org/content/docs/default-source/boc-pdfs/boc-us-reading-lists/pbt_ipbt_reading_list.pdf?sfvrsn=20

ASCP U.S. Procedures for Examination & Certification

https://www.ascp.org/content/docs/default-source/boc-pdfs/exam-content-outlines/ascp-boc-us-procedures-book-web.pdf?sfvrsn=26

TO APPLY ONLINE:

https://www.ascp.org/content/board-of-certification/get-credentialed

PBT ->ROUTE #1 -> APPLY NOW-> CREATE A LOGIN WITH PASSWORD -> SCHOOLD CODE IS 037017