Clinical Registration Form and Information

Clinical Registration Information & Form

You should review and gather all of these items NOW and turn them in before you take your final exam (for Paramedic students, before taking the P2 final exam). Turn all items in at one time using the form upload on this page EXCEPT for your 10 panel Urine Drug Screen. That should be turned in about 60 days in advance of when you want to start rotations. Please email clinical.assistant@percomonline.com when you submit your drug screen at the CFirst approved facility.

Notice from the State:

The DPS crime records service and DSHS has changed from the FAST fingerprint form to a new Texas Fingerprint Service Code Form for criminal background checks. DSHS has noticed an increase in personnel completing fingerprints for their criminal background check before they have filed an application with DSHS. EMS personnel must submit an application for EMS Certification/licensure, Criminal History Pre-Screen Petition, or an Administrator of Record (AOR) form before completing the fingerprint process. Completing fingerprints without submitting an application and/or AOR form to DSHS will cause a delay in processing your application.

Submitting & What to Expect:

Prior to submitting your clinical documents/requirements, save each one by the name of what it is and in pdf format NO PHOTO FILES (i.e. complete_shot_record, TabletPCRequest, TB_skintest, Physical, Insurance, etc.). If you submit the items unlabeled, they will be returned to you unopened and unaccepted to be labeled and resubmitted, which will cause a delay in your approval to begin scheduling rotations. Also, submitting the required items in “bits and pieces” will delay approval as well. Be sure to have all your items ready to submit at one time, including your Drug Screen results from CFirst.

After submitting this form you should expect an email within five business days, confirming address and documents or requesting further items if needed. If you have not received this email within 5 business days, please email clinical.assistant@percomonline.com, copied to programdirector@percomonline.com to check the status on your clinical paperwork submission. Be SURE to check your spam/trash/junk/updates folder(s) prior to sending this email because many times the email from PERCOM may be in one of those places.

Once verified, you will receive scheduling material and begin selecting clinical locations. Dates are depending on your schedule and the schedule of the site. Remember, you must be approved on all paperwork submissions and requirements before you will receive your shirt, nametag, Tablet PC (if requested) and instructions email on how to schedule and document.

Clinical Network and Scheduling:

Students are currently being required to register for clinical and field rotations for EMT and Paramedic classes at least 30 days prior to attending your first rotation. These hours must be completed at affiliated and approved hospitals, EMS agencies and 911 emergency Fire Departments that are within PERCOM’s network. Scheduling your rotations will be handled by the Clinical Department, and it is based on your availability as well as the clinical site availability.

What You Need:

You will need to bring a stethoscope, second hand watch, and black, closed toe sturdy foot wear, as well as wear the PERCOM approved clinical uniform. The uniform consists of a clinical shirt and nametag ID provided by PERCOM and black or dark blue EMS uniform pants.

Drug Screening:

A 10 Panel drug Screening must be completed within 60 days of your first clinical or field rotation. Scheduling and attending your screening can be completed locally by cFIRST through their approved system to order the screen. They utilize nationwide lab service companies that are available in most major cities. If you have difficulty locating a testing center, or have questions about your drug screening after reviewing the information provided by cFIRST, call cFIRST Support at +1-513-898-0646.

If you have not completed the Drug Screen when you submit the rest of your Clinical Paperwork, please email clinical.assistant@percomonline.com and clinicalcoordinator@percomonline.com so that it will be checked in and your Clinical package released and mailed to you

Immunization Requirements:

Immunization records must include a negative TB test within 6 months of the start of clinical rotations (or negative chest x-ray if prior positive), Hepatitis B Vaccine (3 vaccination series), MMR (2 vaccinations), Meningitis, Annual Flu Vaccine, Tetanus(within the last 10 years) and Chicken Pox /Varicella (2 vaccinations). Quantitative Serum Titers showing seroconversion are acceptable. All these tests and vaccinations are required by clinical and field sites for students to be allowed to complete the clinical and field portions of the program.

Some vaccines may have faster vaccination schedules available depending on where you attempt to get your vaccinations. So far, this is specific for the chicken pox/varicella (some sites have a one shot regimen) and HepB (some sites have a two shot regimen). You need to ask if your preferred site has these available and if not, we suggest that you call around. Sam’s and Walmart Pharmacies typically have these available upon request from what we have been told.

Uniforms:

Students are required to wear a PERCOM provided polo and ID as well as carry their CPR card and Insurance information while in clinical. Students we also need to provide their own EMS Navy or Black Pants as well as closed toe fluid resistant shoes.

Clinical Document Downloads

Please open each document, download, print and sign, and then upload in the corresponding box in the CLINICAL REGISTRATION form at the bottom of this page.

Drug Screening may be completed up to 60 days prior to beginning clinical or field rotations. However, all required paperwork must be completed and accepted and the drug screen MUST be completed prior to requesting ANY rotations. To apply for a screening locally, go to cFIRST and follow these directions -> click here. DISREGARD THE “BACKGROUND SCREENING” title on the page! This IS the drug screen signup link! Be aware, C-First will only allow you one week to do the drug screen once they clear you to go take the test. Do NOT exceed the deadline they give you! If you exceed the deadline and we have to call CFirst to get you cleared again, you will be charged $25 plus processing.

Please note that if you have taken more time to complete didactic and the criminal background check we paid for you to do during course enrollment is over 1 year old, you will have to redo the background check through CFirst at your expense before being cleared.

HIPPA

Signed Hippa Agreement form is required to ensure that the parties are aware of their responsibilities under the provisions of the laws of the State of Texas relative to confidentiality and privacy of patient health information and under the Health Insurance Portability and Accountability Act of 1996 (HIPAA)

PHYSICAL EXAM by DR

Take this Physical Form to a local Doctor and have them perform a physical and sign this stating you are in shape to perform EMT or Paramedic duties.

CLINICAL PACKET & TABLET USE

You should download, read, and fill out the following Clinical Packet Request Form and the appropriate Tablet PC form below. After completion, you must upload them in the appropriate section within the CLINICAL REGISTRATION FORM below. If you do not turn this in together with all the other clinical registration paperwork on this page, your clearance for rotations and ability to start requesting your schedule can be significantly delayed.

Table/PC Use:

Clinical Dress Code

Students will wear the uniform designated for the specific clinical program in which he/she will be participating, PERCOM or an educational program holding a Cooperative Agreement for Rotations with PERCOM. Most students will wear the designated PERCOM uniform for all rotations unless otherwise specified (i,e. changing into scrubs for OR or L&D rotations). However, even when expecting to change out, students will wear the desginated uniform to the site and ALL students will wear the designated nametag at all times when in rotations.

The designated uniform for PERCOM students who are not rotating through an affiliated educational program’s Cooperative Agreement will wear the following:

1. Official PERCOM Uniform Shirt
2. Official PERCOM nametag for the level of program (AEMT or Paramedic students may NOT wear their nametag used during EMT school)
3. Dark blue or black squad style uniform pants or dress slacks
4. Black belt
5. Dark blue or black socks
6. Fluid impervious EMS style shoes or boots – black (Some waterproof styles of black athletic shoes may be acceptable. Check with the Clinical Coordinator. NO TENNIS SHOES!)

Make sure you do not show up to a clinical site looking like you just rolled out of bed.

IF YOU SHOW UP TO CLINICAL OUT OF UNIFORM YOU WILL BE SENT HOME AND YOUR SHIFT WILL BE CANCELLED.

Clinical Site Request:

PERCOMOnline, Inc. strives to maintain flexibility for our students. In keeping with this goal, we do allow students to request additions to our clinical or field site network. However, due to current state and national accrediting requirements, this process is limited and site requests are subject to individual approval. If approved, PERCOM will attempt to establish the agreement but this process is not automatic, can take time to establish and sometimes still cannot be established even when all information on the form is complete and accurate. This process should be started early in your course because it could take significant time to complete, and there are no guarantees that the process can be completed in time for you to use the site. To view the form, click the button below.