BELLEVUECOLLEGE

NUCLEAR MEDICINE TECHNOLOGYPROGRAMPROSPECTIVE STUDENT HOSPITALOBSERVATION

NAME:

Use this form to document your nuclear medicine observations prior to interviews for the program.The requirements for applicantsare:

1)You need to observe in at least two nuclear medicine departments. Three hours observation time isabout the maximum for any oneappointment.

2)One of those observations must be in a hospital affiliated with the BC program. These hospitals are listed below. After selecting the affiliate site(s) that you are hoping to visit, please contact Suzanne Lane ( or 425-564-2013) for additional assistance in gathering the required documents. Please note that some sites do not allow job shadowing unless the individual is already a volunteer or employee. If you are listing multiple sites, please designate order of preference (i.e. 1st choice, 2nd choice, etc.)

In the Puget Soundregion:

Harborview MedicalCenter, 325 Ninth Avenue, Seattle, WA

Virginia Mason MedicalCenter, 1100 Ninth Avenue, Seattle, WA Swedish MedicalCenter, First Hill, 747 Broadway, Seattle, WA

Group Health Capitol HillCampus, 201 16th Avenue E, Seattle, WA

Group Health Bellevue Medical Center, 11511 NE 10th, Bellevue, WA Good SamaritanHospital, 401 15th Avenue SE, Puyallup, WA

In SoutheastWashington:

Yakima Valley Memorial Hospital, 2811 Tieton Drive, Yakima, WA

Kadlec Medical Center, 888 Swift Boulevard, Richland, WA

3)If you are from outside of the Seattle/Tacoma area, you should plan to complete the requiredtwo observations in your area prior to the first interview. If you are invited to the second interview, you willbe required to come to Bellevue and/or Richland. You should then schedule an appointment with one ofthe program's clinical sites in conjunction with thattrip.

4)The expectations for observations include providing all required documentation prior to arranging an appointment, appropriate dress (nojeans, no open-toed shoes), and signing a confidentiality form to be in compliance with HIPAA regulations.Your demeanor during the observation will be taken into account in the acceptanceprocess.

5)One of the goals of the observation is for the prospective student to gain a good understanding of thejob description of a nuclear medicine technologist. Please pay attention to all aspects of thejob.

Clinicalsite / Date / Hours ofobservation / Signature of nuclear medicinetech

Acknowledgement

I attest that I have met the above requirements for observation and that the information given above isaccurate. I understand that my professionalism is under consideration during theobservations.

Signature