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CLINICAL PRECEPTOR AGREEMENT (revised 11/06/14) For NonOregon Based ProgramsOffering Advanced Practice Clinical Experience in OregonInstructionsThis form is to provide contact information and signatures
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How to fill out clinical preceptor agreement

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How to fill out clinical preceptor agreement

01
Step 1: Obtain a copy of the clinical preceptor agreement form.
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Step 2: Read the instructions and requirements listed on the form.
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Step 3: Fill out the personal information section including your name, contact details, and any applicable identification numbers.
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Step 4: Provide details about your educational institution or program, such as the name, address, and contact information.
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Step 5: Specify the clinical site or facility where you will be completing your clinical rotations or training.
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Step 6: Indicate the dates and duration of the clinical placement or preceptorship.
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Step 7: Include any additional provisions or requirements, such as liability insurance coverage or immunization records.
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Step 8: Review the completed agreement form for accuracy and completeness.
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Step 9: Sign and date the agreement, and ensure that the preceptor or supervising healthcare professional also signs the form.
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Step 10: Keep a copy of the signed agreement for your records and submit the original to the designated authority or organization.

Who needs clinical preceptor agreement?

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Clinical preceptor agreements are typically needed by students or individuals pursuing healthcare or medical training programs that involve clinical rotations or placements.
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Medical students, nursing students, physician assistant students, and other healthcare professionals in training often require clinical preceptor agreements.
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Hospitals, clinics, and healthcare facilities may also require individuals seeking clinical training to sign a preceptor agreement to ensure a professional and legal relationship between the preceptor and the student or trainee.

What is Clinical Preceptor Agreement - Oregon Form?

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Instructions for the form Clinical Preceptor Agreement - Oregon

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A clinical preceptor agreement is a formal contract between a healthcare educational institution and a clinical preceptor that outlines the roles, responsibilities, and expectations for both parties during the clinical training of students.
Healthcare educational institutions and their clinical preceptors are required to file a clinical preceptor agreement to ensure compliance with regulatory and accreditation standards.
To fill out a clinical preceptor agreement, the involved parties should provide their names, titles, contact information, the scope of clinical training, duration, and any specific roles or responsibilities assigned. It may also require signatures from both parties.
The purpose of the clinical preceptor agreement is to establish a mutual understanding of the expectations and responsibilities of both the educational institution and the preceptor to ensure effective training and compliance with standards.
The clinical preceptor agreement must report the names and qualifications of the preceptor, details of the educational program, the scope of practice during the training, and the responsibilities of both the preceptor and the institution.
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