Get the free Clinical / Field Internship Affiliation Form - NH.gov - nh
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Department of Safety Bureau of Emergency Medical Services 33 Hazen Drive Concord NH 03305-0003 603-271-4568 Clinical / Field Internship Affiliation Form COURSE INFORMATION EMT - BASIC EMT-INTERMEDIATE EMT-PARAMEDIC LOCATION town START DATE END DATE NH EMS I/C Print Name AFFILIATIONS Pursuant to Saf-C 5909. 01 b 2 the EMS I/C shall have written affiliation agreements with each of the listed sites. Please list all Hospitals EMS Units or other sites...
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How to fill out clinical field internship affiliation
How to fill out clinical field internship affiliation:
01
Obtain the necessary forms from your educational institution or the organization coordinating your internship.
02
Complete personal information such as your name, contact details, and student identification number.
03
Provide details about your educational program, including the name of the institution, your major or field of study, and the expected graduation date.
04
Specify the clinical field or specialty in which you will be interning.
05
Indicate the duration of your internship, including start and end dates.
06
Include information about your preceptor or supervisor, such as their name, contact information, and professional credentials.
07
If required, provide proof of liability insurance or any other certifications necessary for participation in the internship.
08
Sign and date the affiliation agreement form, acknowledging your commitment to adhere to the organization's policies and procedures.
Who needs clinical field internship affiliation:
01
Students pursuing degrees in fields such as medicine, nursing, psychology, or social work often need clinical field internship affiliations to gain practical experience.
02
Educational institutions may require students to complete a clinical field internship as part of their curriculum or degree requirements.
03
Professionals seeking to enhance their skills or gain experience in a new specialty may also need clinical field internship affiliations.
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What is clinical field internship affiliation?
Clinical field internship affiliation is a formal agreement between a healthcare facility and an educational institution to provide practical training and supervised experience to students in a clinical setting.
Who is required to file clinical field internship affiliation?
Educational institutions and healthcare facilities are required to file clinical field internship affiliation.
How to fill out clinical field internship affiliation?
Clinical field internship affiliation forms can usually be obtained from the educational institution or the healthcare facility. The forms must be completed with the necessary information and signed by the authorized representatives of both parties.
What is the purpose of clinical field internship affiliation?
The purpose of clinical field internship affiliation is to ensure that students receive hands-on training and supervision in a real-world healthcare environment, allowing them to apply their theoretical knowledge and develop practical skills.
What information must be reported on clinical field internship affiliation?
The clinical field internship affiliation form typically requires information such as the names and contact details of the educational institution and healthcare facility, the duration of the internship, the roles and responsibilities of both parties, and any special requirements or conditions.
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