Welcome to the Master of Science in Nursing Program Purpose of the Handbook
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References Buppert, C. (2000). Complying with patient privacy requirements. Nurse Practitioner, 27 (3), 12-32. Follanskee, N. M. (2002). Implications of the Health Information Portability and Accountability Act. Journal of Nursing Administration, 32 (1), 42-47. Fowler, M. D. M. (2008). Guide to the code of ethics for nurses: Interpretation and application. Silver Spring, Md.: American Nurses Association. Kendig, S. (2003). HIPAA basics: are you ready? Missouri Nurse, (1), 22-23. Kumekawa, J. K. (2001) Health information privacy protection: Crisis in common sense. Online Journal of Issues in Nursing. 6(3), Manuscript 2. Available at : http://www.nursingworld.org/MainMenuCategories/ANAMarketplace/ANAPeriodicals/OJIN/TableofContents/Volume62001/No3Sept01/PrivacyProtectionCrisis.aspx U. S. Department of Health and Human Services. (n.d.) Understanding health information privacy. Retrieved on June 27, 2011 from http://www.hhs.gov/ocr/privacy/hipaa/understanding/
Student Name:______________________________ (Please print) Georgia College & State University College of Health Sciences HIPAA Quiz Answer each of the following questions as either true or false. _____ 1. A major purpose of the HIPAA law is protection of privacy of patients’ health information. _____ 2. As long as the patient’s name does not appear on a document, adequate privacy has been maintained to satisfy HIPAA requirements. _____ 3. Only electronic documents are affected by the HIPAA law -- not paper (hard copy) documents. _____ 4. Nursing students should use only the minimum information necessary to provide patient care and participate in clinical learning. _____ 5. The Georgia Hospital Association oversees HIPAA compliance and reports violators to the state Attorney General’s Office. _____ 6. Sharing patient information inappropriately with the intent of personal gain can result in large fines and imprisonment. _____ 7. Each agency has a designated HIPAA officer that can answer questions about the best means to safeguard privacy of patient health information. _____ 8. Because of HIPAA legislation, nurses are no longer required to report suspected child abuse. _____ 9. A clinic nurse who mails patients’ information about an illness or a support group that might be helpful in coping with that illness has violated the HIPAA regulations. ____ 10. A nursing student tells his wife that during clinical, he helped care for a television celebrity, who had just had knee surgery. This is a violation of HIPAA.
Facility.
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Further, I understand and agree, unless otherwise agreed to in writing, that I will not receive any monetary compensation from the Board of Regents of the University System of Georgia, the Institution or the Facility for any services I provide to the Facility or its clients, students, faculty or staff as a part of my A.L.E. Unless otherwise agreed upon in writing, I also understand and agree that I shall not be deemed to be employed by or an agent or a servant of the Institution, the Regents or the Facility; that the Institution, Regents and Facility assumes no responsibilities as to me as may be imposed upon an employer under any law, regulations or ordinance; that I am not entitled to any benefits available to employees; and, therefore, I agree not to in any way to hold myself out as an employee of the Institution, the Regents or the Facility. I understand and agree that I may be immediately withdrawn from the A.L.E. based upon a lack of competency on my part, my failure to comply with the rules and policies of the Institution or Facility, if I pose a direct threat to the health or safety of others or, for any other reason the Institution or the Facility reasonably believes that it is not in the best interest of the Institution, the Facility or the Facility’s patients or clients for me to continue. Such party shall provide the other party and the student with immediate notice of the withdrawal and written reasons for the withdrawal. I understand and agree to show proof of professional liability insurance in amounts satisfactory to the Facility and the Institution, and covering my activities at the Facility, and to provide evidence of such insurance upon request of the Facility. I further understand that all medical or health care (emergency or otherwise) that I receive at the Facility will be my sole responsibility and expense. This agreement shall apply to all ALE in which I participate as long as I am an enrolled student at GCSU. I have read, or have had read to me, the above statements, and understand them as they apply to me. I hereby certify that I am eighteen (18) years of age or older, or my parent or guardian has signed below; that I am legally competent to execute this Applied Learning Agreement; and that I, or my parent and/or guardian, have read carefully and understand the above Applied Learning Experience Agreement; and that I have freely and voluntarily signed this “Applied Learning Experience Agreement.” This the day of (Month and Year) Signature: Witness Signature: Name: Name: (Please print) (Please print) Parent/Guardian Signature: Witness Signature (if applicable) Name: Name: (Please print) (Please print) 003 AUTHORIZATION FOR RELEASE OF RECORDS AND INFORMATION TO: The Board of Regents of the University System of Georgia or any of its member Institutions (hereinafter referred to as the “Institution”), and any Facility where I participate in or request to participate in an applied learning experience, including but not limited to any Georgia Hospital Association member Facility (hereinafter referred to as the “Facility”) RE: (Print Name of Student) As a condition of my participation in an applied learning experience and with respect thereto, I grant my permission and authorize the Board of Regents of the University System of Georgia or any of its members institutions to release my educational records and information in its possession, as deemed appropriate and necessary by the Institution, including but not limited to academic record and health information to any Facility where I participate in or request to participate in an applied learning experience, including but not limited to any Georgia Hospital Association member Facility (hereinafter referred to as the “Facility”). I further authorize the release of any information relative to my health to the Facility for purposes of verifying the information provided by me and determining any ability to perform my assignments in the applied learning experience. I also grant my permission to and authorize the Facility to release the above information to the Institution. The purpose of this release and disclosure is to allow the Facility and the Institution to exchange information about my medical history and about my performance in an applied learning experience. I further understand that I may revoke this authorization at any time by providing written notice to the above stated person(s)/entities, except to the extent of any action(s) that has already been taken in accordance with this “Authorization for Release of Confidential Records and Information.” I further agree that this authorization will be valid throughout my participation in the applied learning experience. I further request that you do not disclose any information to any other person or entity without prior written authority from me to do so, unless disclosure is authorized or required by law. I understand that this authorization shall continue in force until revoked by me by providing written notice to the accordance with this “Authorization for Release of Records and Information”. In order to protect my privacy rights and interests, other than those specifically released above, I may elect to not have a witness to my signature below. However, if there is no witness to my signature below, I hereby waive and forfeit any right I might have to contest this release on the basis that there is no witness to my signature below. Further, a copy or facsimile of this “Authorization for Release of Records and Information” may be accepted in lieu of the original. I have read, or have had read to me, the above statements, and understand them as they apply to me. I hereby certify that I am eighteen (18) years of age or older, or my parent or guardian has signed below; that I am legally competent to execute this “Authorization for Release of Records and Information”; and that I, or my parent and/or guardian, have read carefully and understand the above “Authorization for Release of Records and Information”; and that I have freely and voluntarily signed this “Authorization for Release of Records and Information”. This the day of 20 Name: (Please print) (Signature) Witness Name: (Please print) (Witness Signature) Parent/Guardian Name: (if applicable) (Please print) (Signature) STUDENT HANDBOOK RECEIPT I have read the Georgia College & State University, College of Health Sciences, Graduate Student Handbook and agree to adhere to the policies stated herein. Student Name___________________________________ (Please Print) Student Signature_________________________________
Student Full Name ___________________________________________ GCID 911____________ Address ________________________________________________________________________ (Street) (City) (State) (Zip) Phone (____)______________________ Email __________________________________________ Semester (check one) ____ Fall ____ Spring ____ Summer Course title ______________________________________________________________________ Course number ________________________ Course Faculty Member _____________________ I agree to the list of responsibilities outlined on page 1 of these policies and procedures. Student’s signature _________________________________________ Date___________________ *************************************************************************************
I am (check one) ____ Educator at a school/college ____Librarian at city library ____Educator at a hospital ____Member of clergy ____ Testing administrator or educational services officer for military As a proctor I agree to the following statements:
Proctor’s signature____________________________________________ Date ______________ Proctors Information (please print) Full Name__________________________________________ Phone (_____)_______________ Institution/Organization _______________________________Fax (_____)__________________ Position________________________________________ Email___________________________ Business Address ________________________________________________________________ (Street) (City) (State) (Zip) ************************************************************************************* Student is required to return this completed for to Faculty Member no later than the third week of Fall, Spring or Summer Semester. Return completed for to: Faculty Member ____________________________________________ Phone(______)______________ Mail to: GCSU School of Nursing, Graduate Department, Macon Graduate Center, 433 Cherry Street, Macon, GA 31201, or fax to Attn: Jess Tanner, 478-752-1077. Please keep a copy for your records D  istance Education
Online Course Exam Proctor Policies and Procedures The Roles and Responsibilities of the Online Student Regarding Proctored Exams: The Online Student is responsible for:
The Roles and Responsibilities of the Proctor:
The Roles and Responsibilities of the Faculty Member Regarding Proctored Exams:
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