HUC Fall 2016 Packet - Lake Superior College

Workforce and Community Development
Continuing Education & Customized Training
2101 Trinity Road, Rm. E2060, Duluth, MN 55811
Phone: 218-733-5924 ● Fax: 218-733-5974 ● [email protected]
Health Unit Coordinator (HUC) Course Information
Fall 2016
DESCRIPTION
Health Unit Coordinators (HUC’s) work at the nursing station in many health care facilities and are at the center of
communications on the nursing unit.
HUC’s complete detailed tasks with multiple priorities in a complex and fast-paced environment with many
interruptions. They perform with minimal supervision, work independently and solve problems. Excellent written
and verbal communication skills are a must. HUC’s must adhere to a high degree of ethics and maintain patient
confidentiality at all times.
The Health Unit Coordinator Course provides instruction that enables you to perform as an entry level Health
Unit Coordinator in a hospital or extended care facility or other positions such as Patient Service Assistants,
Surgery Schedulers, Registration Interviewers, or Patient Care Coordinators.
PARTICIPANT REQUIREMENTS
● Apply for and receive NET Study background clearance
● Current Physical Exam signed by physician
● Current & complete Immunization Records signed by provider (including Mantoux)
● Proficient computer and keyboarding skills
● This is a college-level course requiring 10th grade reading and writing skills
COURSE DETAILS
Hours/CEU’s:
Date:
Times:
Location:
Instructor:
Cost:
Book:
128 hours (88 Classroom + 40 Clinicals) / 12.8 CEU’s
August 31 – December 19, 2016
Campus Lecture: Mon. & Weds., 5:00-9:00pm
Clinicals Off-Site: Wed. & Fri
Lake Superior College, Room E2024
Lorie Clark
$1,000 - includes classroom supplies only, book not included
"Health Unit Coordinating" 7e by Elaine A. Gillingham ISBN-10: 1455707201 or ISBN-13: 978145570
PAYMENT OPTIONS
Full Payment is due at time of registration payable with cash, check, or credit card. A Letter of Authorization is required
for a 3rd Party funding source.
REFUND POLICY
Refunds will be issued if the class is dropped or date changes are made 2 days prior to start date. Full refunds issued if
session is canceled. Last day to register: 2 days prior to the first class.
Individuals with a documented disability may request reasonable accommodations from the LSC Disability Coordinator at 218-733-7650 (voice)
or 800-627-3529 (MSR/TTY).
Necessary Steps for Success
Health Unit Coordinator (HUC) Course
1. Register for Class.
2. Apply for NET Study Background Clearance through the MN Dept.
of Human Services and print off confirmation.
Note: LSC is not affiliated in any way to MNDHS. They are a separate entity
and require their own non-refundable background study fee of $20 to be
paid by credit or debit card directly to their agency.
3. Schedule a Physical Examination with your Health Care Provider.
Note: Remember to bring the Health Occupation Programs - Physical
Examination Form & the Immunization Record with you to your
appointment. They both MUST be signed by your physician.
4. Purchase your book.
"Health Unit Coordinating" 7e by Elaine A. Gillingham
ISBN-10: 1455707201 or ISBN-13: 978-1455707201
5. Bring your COMPLETED health packet with required signatures to
Class.
Health Packet Turn-In Checklist
1. Health History Form – Complete with your signature (1 page)
2. Physical Examination Form – Complete with physician’s signature (2 pages)
3. Immunization Record – Filled-in and complete with health care provider’s
signature or filled-in with official immunization records attached (1 page)
4. NET Study results from MNDHS – If you have not received your results
you may turn in the confirmation page stating you completed your NET Study.
Health Occupation Programs
Health History Form
(To Be Completed & Signed by the Student)
Program: (Check One)
o Associate Degree Nursing
o Medical Assistant
o Phlebotomy
o Radiologic Technology
o
o
o
o
o
o
o
o
o
Health Unit Coordinator
Dental Hygiene
Medical Lab Technician
Practical Nursing
Respiratory Care Practitioner
Massage Therapy
Nursing Assistant
Physical Therapist Assistant
Surgical Technology
Students name: ______________________ ______________________ ________________________ _____________________
Last
First
Middle
Maiden
Address: ______________________________________________ ___________________________ __________ ____________
Street
City
State
Zip Code
Phone: (______) ________-________
Home
(______) ________-________
Work
(______) ________-________
Cell
DOB: ____________
MM/ DD/ YYYY
Emergency Contact: ________________________________________ ________________________ (______) ________-________
Name
Relationship
Phone
__________________________________________ _________________________ __________ __________
Street
City
State
Zip Code
Check appropriately for the following - Have you or have you ever had:
Yes
No
□
□
Rheumatic Fever
□
□
Emotional Disorder/Disability
□
□
Color Blind
□
□
Diabetes
□
□
Allergies to Latex**
**If yes, please see Health Services**
Yes
□
□
□
□
□
No
□
□
□
□
□
Heart Disease
Back Injury
Hemophilia
Asthma
Epilepsy/Seizures**
Please specify all allergies: _______________________________________________________________________________________________
Please read carefully and sign:
I understand that there are conditions for which accommodations may be appropriate under the Americans with
Disabilities Act and that the Health Occupation Programs will make all reasonable accommodations required by law for
otherwise qualified individuals. To receive accommodations, I must contact the Office for Students with Disabilities.
I understand that any health care costs incurred during the period of time I am a student in the Health Occupation
Programs will be my responsibility.
I hereby grant Lake Superior College permission to share information contained in the Health Examination and Immunity
Requirement forms with those clinical institutions with whom I affiliate in my student role, should the clinical institution
request or require it.
I understand that failure to sign this form or to provide the information requested in the Health Examination and Immunity
Requirement forms could mean that a clinical site may refuse me placement at their facility. The Health Occupational
Programs do not guarantee an alternative facility placement. I also understand that if no alternative facility placement is
available, I may be terminated from the Health Occupational Programs.
____________________________________________________
Student’s Signature
_________/__________/__________
Month
Day
Year
Health Occupation Programs
Physical Examination Form
To be Completed & Signed by the Physician or their Designee:
EXAMINER: the individual presenting this form is admitted to the Lake Superior College Health Occupation Programs.
You are asked to make careful examination of the individual and their history to determine if the individual is in
sufficiently good health to undertake a program in health occupations.
Student Name: ______________________ ______________________ ______________________ ______________________
Last
First
Middle
Maiden
Blood pressure: __________ / __________
Vision: Is the student’s visual ability sufficient for observation, assessment, and performance of safe patient care such as reading of
mercury and digital thermometers, sphygmomanometers, fine print on drug vials and literature, demarcations on insulin,
tuberculin and other syringes, computer terminals and medical records, etc.
Check appropriate response:
______ Yes, without correction
______ Yes, with correction
______ No
Comment(s):
Hearing:
Is the student’s auditory ability sufficient to hear normal conversation and/or assess health needs such as telephone
conversations, auscultation of blood pressures, apical pulse, lung and bowel sounds using a stethoscope, hear and
locate source of equipment warning signals when in or outside patient rooms, etc.
Check appropriate response:
____ Yes, without use of hearing aid(s) or adaptive equipment
____ Yes, with adaptive equipment (e.g., amplified stethoscope)
_____ Yes, with hearing aide(s) [_____left_____right]
_
_____
No
right]
_
Comment(s):
Ambulation:
Is the student’s ambulatory capability sufficient to maintain a center of gravity when met with an opposing force as
in lifting, supporting, and/or transferring a client. Can the student tolerate long periods of sitting and/or standing?
Check appropriate response:
______ Yes
______ No
Comment(s):
Weight Bearing/Lifting: Is the student sufficiently able to bear or lift weight to accomplish common health occupation functions
such as moving and lifting patients in bed, wheelchair or cart, assist with transfer and walking of patients
who may require substantial support and moving of heavy equipment (e.g., hospital beds, meal carts), any
of which may involve moving or supporting equal or greater weight than the student themselves (25 pounds
frequently, 50 pounds less often).
Check appropriate response:
______ Yes
______ No
If the student is unable to perform the listed weight bearing/lifting activities, please state below:
1.
Why (nature of the problem)
2.
If any restriction(s) in bearing and/or lifting of weight and/or bending exist and state the specific restriction(s)
3.
If the restriction(s) is/are permanent or temporary (give date of anticipated removal of restriction(s), if temporary)
Comment(s):
Health Occupation Programs
Physical Examination Form Continued
Immune Status: Health Occupation students are assigned in clinical areas where exposure to infection and communicable disease is
common. Is the student’s immune response or status sufficient to allow assignment in all clinical areas and to all
patients (assuming use of protective measures ordered by the facility)?
Check appropriate response:
______ Yes
______ No
If the student’s immune response or status is not sufficient to allow assignment in all clinical areas and to all patients (assuming
use of protective measures ordered by the facility), please state below:
1.
2.
The condition(s) and/or treatment which make the student vulnerable to infection
If there is a:
a.
permanent problem
b.
temporary problem. If so, state date when student may be exposed to pathogens commonly found in a hospital
setting.
c.
episodic problem. If so, describe the student’s current status.
Comment(s):
Examiner:
I certify that this individual’s immunizations are current and he/she does not have any health problems which would jeopardize either
the student’s welfare or patient’s welfare and does not have any limitations which would restrict them from performing the customary
duties of a health occupation student/employee.
______________________________________________________________________________
( Signature of Examiner)
(Credential)
_______________________________
(Date)
________________________________________________________________________________________________________________
(Name of Examiner -PRINTED)
(Cre dential – PRINTED)
_______________________________________________________________________________
_______________________________________________________________________________
(________) __________ -__________
(Clinic Phone Number)
(Clinic Name and Address)
DO NOT SIGN BELOW UNLESS ONE (1) YEAR AFTER YOUR PHYSICAL
One-Year Update
___________ There has not been any changes in my health status in the past twelve (12) months.
Student’s Signature
Date
or
__________ There have been changes in my health status in the past twelve (12) months.
Please provide recent exam/report from physician.
**Student must inform program of any changes in health status as they occur**
Communicable Disease Immunity Screening Form for Healthcare Students
Name of Healthcare Student:_____________________________________
Date of Birth: ________________________
Please have the PROVIDER THAT MAINTAINS RECORDS OF YOUR IMMUNIZATIONS AND IMMUNITY HISTORY COMPLETE THIS
FORM. An official copy of your immunization/immunity records (Doctor’s Office, Schools, Military) may be attached to this form.
Persons who are unable to provide evidence of immunity, will be required to be tested and/or immunized, as indicated.
Name of facility/provider providing information: ____________________________________________
Phone: _________________Signature of provider providing information: _________________________
Required Immunity
The above named person has documentation of: ( 
all items that apply)
Disease
Measles
A positive antibody test for measles
Date(s)
OR
Two (2) doses of measles or a measles/mumps/ rubella (MMR) vaccine received after
st
1 birthday
Mumps
A positive antibody test for mumps
OR
Two (2) doses of Mumps or a measles/mumps/ rubella (MMR) Vaccine received after 1
birthday
A positive antibody test for rubella
Rubella
st
OR
One (1)dose of rubella or a measles/mumps/ rubella (MMR) vaccine received after 1
birthday
st
One dose of tetanus, diphtheria, pertussis (Tdap) vaccine
Pertussis
NOTE: Tdap is not the same as the other vaccines containing some or even all of the vaccine
components (D-T-A-P) such as DTap, Td, or DT. Within the last 10 years
Varicella (Chickenpox)
Physician diagnosed varicella or herpes zoster
OR
A positive antibody test for chickenpox (varicella zoster)
OR
Two (2) doses of Varivax (Chickenpox Vaccine)
Date
Evidence of negative tuberculosis screening within the past 90 days (method )
A negative Tuberculin Skin Test (TST) performed within the past 90 days
Date:
induration:
mm
NOTE: TST is another name for PPD or Mantoux test
Tuberculosis (TB)
If this is the first test for this person, or if it has been more than 90 days since the
person had a negative TST, a two- step test is required. If the first TST is negative, the
second TST must be administered 1-3 weeks after the first test is read.
Date:
induration:
mm
OR a negative Quantiferon-TB (QTB ) or T-Spot blood test within the past 90 days
OR IF history of positive TST OR QUANTIFERON-TB* Test
medical clearance by provider including a chest X-ray within the past year.
If this box is checked, attach a copy of the most recent chest x-ray and medical
evaluation / treatment.
Dose 1 Date
Hepatitis B
Dose 2 Date
Dose 3 Date
Titre Date
Report 3 doses
or
/
Titre date & results
/
or
MM
/
/
DD
YYYY
MM
/
DD
YYYY
Signed Waiver
October 1 thru March 31
Meningococcal
/
MM
DD
MM
YYYY
Results
(Recommended for Med Lab Tech Students Only)
Influenza - annual
/
/
DD
YYYY
Date
RECOMME
NDED (not
mandatory)
1 dose of influenza vaccine for current influenza season
MCV4 vaccination
If student is pregnant and vaccinations are needed to meet immunity requirements, they MUST be received after delivery. If pregnant, please indicate:
Due Date:
Form Revision Date:
4/9/14
Please bring this to Orientation.
PHOTOGRAPH CONSENT FORM
I hereby give Minnesota State Colleges and Universities, and its successors and assignees, the right to
use, reproduce and distribute my photograph for educational, publication or marketing purposes
without any compensation to me.
I understand that MnSCU shall have total and exclusive control over the use of my photograph, and
I waive any rights to inspect or approve any proposed publications in any medium. I hereby release
MnSCU and its successors and assignees from any liability by virtue of my photograph.
I hereby give Minnesota State Colleges and Universities the right to use quotations attributed to me for
educational, promotional or marketing purposes without further compensation. I consent that all of this
material shall be solely and completely the property of Minnesota State Colleges and Universities.
I state that I am at least 18 years of age and am competent to contract in my name. (If not at least 18,
must have signature of a parent or guardian.) I have read and understand the above.
Name
Signature
Address
City
Phone
State
ZIP
Signature of Parent/Guardian
Witness Name
Date
MEMORANDUM
TO:
All Employees/Lake Superior College
FROM:
Pat Johns, President
DATE:
November 7, 2014
SUBJECT:
Inclement Weather or Other Emergencies
The authority to cancel classes, or close the college due to inclement weather
conditions, or other emergencies, resides with the college president or designee.
The closure of state agencies by the Commissioner of the department of
Management and Budget does not apply to MnSCU institutions (Lake Superior
College).
Administration is currently in the process of approving a college procedure,
1A.11.2, on emergency closings.
The following will govern cancelation and closure due to inclement weather or
other emergencies for all employees:
CLASSES CANCELLED - ALL FACULTY AND STAFF EXPECTED TO REPORT
The college president makes the decision to cancel a class or classes. Students are
not expected to attend, but cancellation of classes does not excuse any employee
from work. ALL employees of the college, including faculty, may take personal
leave, vacation leave or use earned compensatory time when classes are canceled
and they choose to be absent from work. (Board Policy 4.4, Part 1)
COLLEGE CLOSED
The college president or designee makes the decision to close the college. When
the college is declared closed all college employees are excused from work with
pay. College closure applies to all employees regardless of labor contract.
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The declaration of college closure shall, whenever possible, identify the
timeframe when employees are excused from work.
TELEPHONE AND WEBSITE NOTIFICATION GOVERNING CANCELLATION
OF CLASSES OR COLLEGE CLOSING
To make it easier for everyone to verify if classes are canceled or the college is
closed due to inclement weather or other emergencies, the following notification
system will be activated once the college president or designee determines that
classes will be canceled or the college will be closed.
Broadcast Media
Radio stations: KTCO-FM 98.9, KDWZ-FM 102.5, KDAL-FM 95.7, KDAL-AM
610, WGEE-AM 970, WDSM-AM 710, KKCB-FM 105.1, KLDJ-FM 101.7, KBMX-FM
107.7, WEBC-AM 560, KZIO-FM 94.1, KQDS-FM 94.9, WWAX-FM 92.1, and KQDSAM 1490.
Broadcast television stations: (Broadcast stations are listed; cable and satellite
system channels vary by system): KDLH 3, KBJR 6, WDIO 10/13, and FOX 21.
Website
LSC will post a notification to the front page of the college website
(http://www.lsc.edu). Websites operated by the broadcast media identified
above and the Duluth News Tribune will also post information about campus
cancellations.
Star Alert and Social Media
Employees and students who signed up via www.lsc.edu/staralert will receive a
text message and/or e-mail from Star Alert Emergency Notification System
notifying them of any weather-related closures. LSC's Facebook and Twitter feeds
will also provide timely weather-related closure announcements.
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