Clinical Code of Conduct Report Form 

To be completed by overseeing clinitians in the instance of students exhibiting "at risk" behaviors, which violate the Allied Health Department's Clinical Code of Conduct.  

Complaint Form

To be completed by students with concerns or complaints in courses they are currently taking or have taken. 

Clinical Practice Evaluation Packet 2020

To be completed by overseeing clinitians, this form evaluates both student's technical performance and interpersonal apptitude during clinical education. Separate forms for students' microbiology, chemistry, hematology/coagulation and uninalysis rotations are included, as well as sign in form intended to document students' attendance.  

Bloodborne Pathogen Exposure Incident Report 

To be completed by students who have been exposed to bloodborne pathogens during clinical education.  

Pregnancy Release Form 

To be completed by both female and male students annually. A pregnant student in the MLT program is required to make her condition known to the head of the nursing program and her clinical instructor and to submit appropriate documentation from her attending physician or health care provider. As a result of learning activities, students may be exposed to risk factors such as but not limited to communicable diseases, strenuous activity, toxic substances and radiation.

MLT/Phlebotomy Health Clearence Form

To be completed by all MLT program students, this form gives MLT staff and admin permission release student submitted health information to any affiliating clinical agency where students are assigned for clinical experience studies in the program.