Colorado Area Health Education Center Program

In partnership with Central Colorado AHEC

2016 Summer Health Careers Institute

PARTICIPANT PACKET

PACKET CONTENTS

Participant Information / Pages 2-3
Participant Contract* / Page 4
Participant Release of Liability Form* / Page 5-6
Participant Emergency and Medical Info./Waiver, Release, & Notice of Risk* / Pages 7-8
Participant Confidentiality Form* / Page 9

*These completed forms along with a copy of your immunization records and a negative TB test

need to be returned by Friday, July 15, 2016to

Jennifer Hellier by mail in one envelope

Mail: Jennifer Hellier, PhD, Assistant Professor

Director of Colorado Health Professions Development Program (CO-HPD)

Associate Director of Programs

Colorado AHEC Program Office

University of Colorado - Anschutz Medical Campus

13120 E. 19th Ave, MS-F433

Aurora, CO 80045

2016SUMMER HEALTH CAREERS INSTITUTE (SHCI)

PARTICIPANT INFORMATION

The following information will apply to participants in preparing for our five-dayprogram from

August1–5, 2016.

MEALS:

Participants to the SHCI will receive breakfast and lunch during the program.

If you have any food allergies or special needs, please be sure to complete and return the “Medical Release and Consent Treatment Form” by Friday, July15, 2016.

OTHER INFORMATION:

Loss of Personal Property: The Summer Health Career Institute (including the Colorado AHEC Program Office, University of Colorado, and Central Colorado AHEC) will assume NO responsibility for theft, destruction, or loss of money or personal property. Participants should exercise every precaution in assuring the safety of their own property. Immediately, report to Michael Flowers or your Team Leaderif any items that are stolen or missing.

  1. Transportation: Participants are responsible to transport themselves to each activity, either at the University of Colorado-Anschutz Medical Campus (13120 E. 19th Ave, Aurora, CO 80045) or Community College of Aurora (9235 E. 10th Drive, Denver, CO 80230). DPS will provide a shuttle bus for pick-up at CEC, George Washington, and Manual high schools. If you have questions, please contact:
    Karis Morrall
    720-423-6454
  1. Telephones and Technology: Participants will be asked to observe strict rules of etiquette and limits on personal cell phone use (i.e., turn off ringer and do not answer phone calls or text messages during classes, seminars, job-shadowing, etc.). In case of an emergency, please step out-of-the classroom to answer phone calls. These rules also apply to other devices (e.g., MP3 players, video, etc.). If a participant violates these rules, then the first time they will be warned and the second time the phone or device will be taken away.
  1. If a parent/guardian needs to contact a participant or if it is an emergency, please contact:

Mitch Fittro at 720-863-8199

or

Michael Flowers at 720-320-2386

PARTICIPANT EXPECTATIONS:

Participants will be learning about health careers by participating in program activities and understanding HIPAA privacy laws. We will use computers and work in groups to discover more about the world of work as it relates to health careers.

P.R.I.D.E. Participants will have the opportunity to show pride throughout the SHCIexperience in each of the following ways:

Professionalism – We will be in professional environments and should match our attitudes and clothing to those environments. Participants will be expected to wear clothing that covers their cleavage, midriff and backside; no underwear should be exposed.

Respect – In the work world, it is imperative that we treat our hosts and each other with respect. This includes paying attention to our speakers without side conversations, and asking appropriate questions.

Integrity – Confidentiality will be a key component. Names and specific details that participants experience cannot be shared with anyone outside the group. The Health Insurance Portability and Accountability Act (HIPAA) protects specific patient information and strictly prohibits sharing this information without express consent from the patient.

Dedication – There will be assignments and expectations regarding completion of this program. Participants will be required to participate in all activities. Non-compliance will be cause for sending participants home.

Excellence – Participants are expected to give their best effort. The best way to ensure having a good experience is to approach this program with a “go-for-it” attitude.

WHAT TO BRING AND WHAT NOT TO BRING:

  1. Professional clothing must be worn most of the time. You will need to bring nice slacks/skirts (girls only) and nice shirts for most of the program agenda items. Include a warm sweater, sweatshirt or jacket for use in cool classrooms. Comfortable clothing, jeans, and shorts will be allowed for some activities.

Important Dress Code for Job Shadowing:

You will be in a health professional’s office, hospital, or clinic for your career experience and appropriate dress is required. All students will be required to wear khakis/dress slacks/dress skirts (girls only), nice shirt or blouse with sleeves, and comfortable, closed toe shoes. No athletic shoes or sandals may be worn in a health clinic. Casual dress shoes are required; no high heels allowed. (Remember you will be standing and walking all day). We are serious about this requirement on this day. If you have any questions regarding appropriate dress for your career experience, please contact Mitch Fittro before coming to the Program. If you do not follow this dress requirement, you WILL NOT BE ALLOWED to participate in the career experience. NOTE: Closed toe shoes are required for job shadowing. Sandals and athletic (tennis/running) shoeswill not be allowed during job shadowing.

2.Raincoat, windbreaker, rain poncho or umbrella for inclement weather.

2016 SUMMER HEALTH CAREERS INSTITUTE

PARTICIPANT CONTRACT

This is a contract betweenthe University of Colorado, the Colorado Area Health Education Center (AHEC) Program, and Central Colorado AHEC and ______(name of parent/guardian), on behalf of,______(name of participant), a participant in the 2016Summer Health Career Institute.

During the time the Participantis at the University of Colorado or any other location as part of the above-referenced program, the Participant agrees to:

  • Commit to successfully complete the program;
  • Adapt to and learn from the environment and comply with all SHCI rules;
  • Be respectful of other participants, team leaders and staff;
  • Attend all scheduled meetings, classes, activities and work on time;
  • Turn in all assignments (if required) on time;
  • Meet with team leaders, teachers and other educators when scheduled;
  • Pay for any repairs or replacements of property damaged;
  • Not possess or use alcoholic beverages, marijuana, or any illegal substances while enrolled in the program;
  • Not smoke or use smokeless tobacco or marijuana while enrolled in the program;
  • Not possess or use any weapon or object of injury while enrolled in the program;
  • Not engage in sexual misconduct while enrolled in the program; and,
  • Not infringe upon the rights of the others participating in the program.

The Participant understands the Colorado AHEC Programprovides meals and activity entrance fees during participation in the Summer Health Careers Institute at the University of Colorado. Valuable jewelry and property should be left at home. The University of Colorado,the Colorado Area Health Education Center (AHEC) Program, and Central Colorado AHECstaff are not responsible for lost or stolen property. The following expenses will be the Participant’s responsibility:

  • Any additional food, social/recreational activities that are not paid for by the program;
  • Charges for damaged property; and,
  • Any medical care or prescription drugs.

I have read the above and understand that failure to comply with any of these expectations will result in disciplinary action and possibly early program termination.

Participant’s Name______Date ______

Participant’s Signature ______

For Participants under 18 years of age

Parent/Guardian’s Name ______Date ______

Parent/Guardian’s Signature ______

2016 SUMMER HEALTH CAREER INSTITUTE

PARTICIPANTRELEASE OF LIABILITY

I, ______(parent/guardian), hereby give permission for ______(name of Participant) to attend the 2016Summer Health Career Institute (SHCI) sponsored by the Colorado Area Health Education Center (AHEC) Program, Central Colorado AHEC, and the University of Colorado. I understand that ______(name of Participant) will participate in all the sessions at the University of Coloradoand various other locations.

I further understand that the University of Colorado, the Colorado Area Health Education Center (AHEC) Program, and Central Colorado AHECwill exercise reasonable supervision of all planned activities including any off-campus activities.

I understand that all participants must be in compliance with and abide by all the rules, regulations, and policies established by the University of Colorado, the Colorado Area Health Education Center (AHEC) Program, and Central Colorado AHEC. Furthermore, the University of Colorado, the Colorado Area Health Education Center (AHEC) Program, and Central Colorado AHECwill not be responsible for any accidents, injury or other misfortune which occurs as a result of a participant’s violation of these rules, regulations and policies, but will see that emergency medical care is provided.

RELEASE OF LIABILITY

This release of liability is executed on this day ___ in the month of , 2016, by the following participant, herein referred to as Releaser, in favor of University of Colorado, the Colorado Area Health Education Center (AHEC) Program, and Central Colorado AHEC.

In consideration of the participant being allowed to participate in the Summer Health Careers Institute, Releaser hereby acknowledges that I have had the opportunity to determine the nature of the activity and the manner in which it will be conducted and having such knowledge or having waived the right to obtain such knowledge do hereby personally assume all risks in connection with said activity and further release University of Colorado, the Colorado Area Health Education Center (AHEC) Program, and Central Colorado AHECinstructors, coaches, agents, employees, operators, officers, and trustees from liability for any harm, injury or damage which may befall the participant while engaged in this activity, traveling to or from the activity site or arising from the participant's presence at the site or in the site vicinity, including all risks connected therewith, whether foreseen or unforeseen; and further agree to save and hold harmless Colorado AHEC Program and the Regents of the University Colorado, and the above mentioned persons from any claim by me, the participant, or my family, estate, heirs, or assignees, arising from the aforesaid activity and circumstances.

Releaser states that I fully understand the terms herein are contractual and not a mere recital and that I have signed this document of my own free act. Releaser states that I have fully informed myself of the content of this release by reading it before signing it and verifying that I am 16 years or older.

Participant’s Name______Date ______

Participant’s Signature ______

For Participants under 18 years of age

Parent/Guardian’s Name ______Date ______

Parent/Guardian’s Signature ______

This two-page document is required for all participants and is not valid if either page is missing.



2016SUMMER HEALTH CAREERS INSTITUTE

Participant Confidentiality Agreement

Dear Participant:

As part of the 2016Summer Health Careers Institute, you will be visiting and participating in learning and educational activities in numerous healthcare facilities. The Health Insurance Portability and Accountability Act of 1996 (HIPAA) demands strict standards of confidentiality from healthcare workers, as well as participants and visitors. You will be participating in a HIPAA training session as part of the program, in preparation for your job shadow experience. In the course of this program, you may have access to certain data and information that is considered confidential, including, but not limited to information about patients or business practices.

You are therefore asked to sign the confidentiality agreement below:

I agree that any and all data and information that I may receive or otherwise discover while observing is considered "Confidential Information". I agree that I will not disclose or discuss any Confidential Information while I am a Participant in the Program or at any time after my Program is completed. I agree that I will keep such data and information confidential and will comply with all laws and regulations concerning the confidentiality of such records to the same extent as such laws and regulations apply to the University of Colorado, the Colorado Area Health Education Center (AHEC) Program, and Central Colorado AHECor other facilities in which I am job shadowing. I further agree that after my Program, I will return to the University of Colorado, the Colorado Area Health Education Center (AHEC) Program, and Central Colorado AHECor to any other facilities in which I am job shadowing any and all documents and copies that I have in my possession that contain Confidential Information.

Participant’s Name______Date ______

Participant’s Signature ______

For Participants under 18 years of age

Parent/Guardian’s Name ______Date ______

Parent/Guardian’s Signature ______

1

Revised March2016