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Appendix B Clinical Student Disclosure Statement To be Retained by the Educational Institution Student Name: Date of Birth: Educational Institution Name: Training Program: 1. I certify that I have

How to fill out clinical student disclosure statement

How to fill out a clinical student disclosure statement:

1. Start by gathering all the necessary information: Before filling out the clinical student disclosure statement, gather the required information such as your personal details, contact information, educational background, and any relevant clinical experiences or internships you have had.
2. Provide accurate and complete information: It is essential to ensure that the information you provide in the disclosure statement is accurate and up-to-date. Double-check details such as your name, address, and contact information to avoid any errors.
3. Disclose any relevant past experiences: The purpose of the clinical student disclosure statement is to disclose any past experiences that could potentially impact your ability to perform clinical duties. Be honest and transparent about any previous medical conditions, physical limitations, or legal issues that might affect your ability to participate in clinical activities.
4. Include educational qualifications: Provide information about your educational qualifications, including the name of the institution you are attending, the program or course you are enrolled in, and your expected graduation date. This information helps the clinical site assess your readiness and eligibility for clinical placement.
5. Follow the instructions provided by the institution or clinical site: Some institutions or clinical sites may have specific guidelines or templates for filling out the student disclosure statement. Follow these instructions carefully to ensure that you complete the form correctly and provide all the necessary information.

Who needs a clinical student disclosure statement?

1. Students pursuing healthcare-related degrees: Any student currently enrolled in a healthcare-related program such as nursing, medicine, pharmacy, or physical therapy may be required to complete a clinical student disclosure statement.
2. Students participating in clinical placements or internships: Students who are required to complete clinical rotations, internships, or other practical experiences as part of their educational program often need to fill out a clinical student disclosure statement. This statement helps clinical sites assess the student's suitability for placement and ensures the safety of both the student and the patients.
3. Educational institutions and clinical sites: The clinical student disclosure statement is typically required by both educational institutions and the clinical sites where students will be placed. This document helps the educational institution assess the student's readiness for clinical work and ensures that the clinical site has all the necessary information to provide a safe and supportive learning environment.

Overall, filling out a clinical student disclosure statement requires providing accurate and complete information about your personal details, educational qualifications, previous experiences, and any factors that might impact your ability to participate in clinical activities. This document is crucial for students pursuing healthcare-related degrees and participating in clinical placements, as well as for the educational institutions and clinical sites involved.

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What is clinical student disclosure statement?

The clinical student disclosure statement is a form that includes information about the student's health, criminal record, or other relevant details that may affect their ability to participate in clinical activities.

Who is required to file clinical student disclosure statement?

Clinical students who are participating in clinical activities are required to file the clinical student disclosure statement.

How to fill out clinical student disclosure statement?

To fill out the clinical student disclosure statement, students must provide accurate information about their health history, criminal record, and any other relevant details.

What is the purpose of clinical student disclosure statement?

The purpose of the clinical student disclosure statement is to ensure the safety and well-being of patients and staff in clinical settings by identifying any potential risks or issues related to the student's health or background.

What information must be reported on clinical student disclosure statement?

Information that must be reported on the clinical student disclosure statement includes health history, criminal record, and any other relevant details that may affect the student's ability to participate in clinical activities.