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Attachment C Sample Preceptor Agreement New York State Department of Health Certified Sexual Assault Forensic Examiner (SAFE) Training Program Preceptor or Supervising 1 Preceptor Agreement I, agree

How to fill out sample preceptor agreement

Steps to fill out a sample preceptor agreement:

1. Gather necessary information: Before filling out the preceptor agreement, collect all relevant details such as the preceptor's name, contact information, organization, and their role or specialty.
2. Introduction section: Start by filling in the introductory section of the agreement. Include the date and the names of the parties involved - the preceptor and the organization or educational institution.
3. Objectives and expectations: Clearly state the objectives and expectations of the preceptorship program. This section should outline the purpose of the agreement, the specific goals of the program, and the expected outcomes.
4. Roles and responsibilities: Define the roles and responsibilities of both the preceptor and the student or mentee. This section should outline each party's obligations, including the preceptor's duties in providing guidance, teaching, and supervision, as well as the student's responsibilities in learning and meeting specific requirements.
5. Time commitment and schedule: Specify the anticipated duration of the preceptorship and the expected time commitment from both parties. Outline the schedule, including the days, hours, and locations of the preceptorship activities.
6. Confidentiality and HIPAA compliance: Address the issue of confidentiality and HIPAA compliance. Emphasize the importance of maintaining patient privacy and confidentiality and ensure that the preceptor agrees to abide by all applicable laws and regulations.
7. Evaluation and feedback: Establish a system for evaluating the preceptorship program and providing feedback. Include a section that outlines the process for assessing the preceptor's performance and the mentee's progress.
8. Signatures and dates: Provide space for both parties to sign and date the agreement. It's crucial to ensure that all parties have reviewed and understood the terms of the agreement before signing.

Who needs a sample preceptor agreement?

1. Healthcare organizations: Healthcare institutions, clinics, and hospitals that offer preceptorship or mentorship programs for students or professionals may require a sample preceptor agreement to outline the terms and expectations of the program.
2. Educational institutions: Colleges, universities, and other educational organizations may use a sample preceptor agreement to formalize the relationship between students and preceptors during clinical rotations or experiential learning.
3. Preceptors: Experienced healthcare professionals who volunteer or are appointed to provide guidance and supervision to students or mentees may need a sample preceptor agreement to clarify their roles, responsibilities, and expectations in the program.

For pdfFiller’s FAQs

What is sample preceptor agreement?

The sample preceptor agreement is a document outlining the expectations and responsibilities of a preceptor and a student during a clinical placement.

Who is required to file sample preceptor agreement?

The preceptor and the student are required to file the sample preceptor agreement.

How to fill out sample preceptor agreement?

The sample preceptor agreement can be filled out by providing information about the preceptor, student, clinical placement details, expectations, and responsibilities.

What is the purpose of sample preceptor agreement?

The purpose of the sample preceptor agreement is to ensure clarity and alignment between the preceptor and student regarding their roles and responsibilities during the clinical placement.

What information must be reported on sample preceptor agreement?

The sample preceptor agreement must include details about the preceptor, student, clinical placement site, goals of the placement, schedule, and evaluation criteria.

Where do I find sample preceptor agreement?

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