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Applicant Information

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Placement Request

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Immunization Record

We are dedicated to protecting you and our patients from infectious disease. The chart below must be filled out for the listed vaccinations. Also, documentation of the following immunizations is required to begin your shadowing experience. A photocopy of your immunizations record must be emailed to ??? as proof of immunization. 

Required Vaccinations

2 Varicella vaccinations, written documentation of disease (Chicken Pox) from healthcare provider, or laboratory evidence of immunity.

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2 MMR vaccinations or laboratory confirmation of disease immunity.

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Tdap (Tetanus/ Diphtheria/ Pertussis)

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Flu Shot ( Beginning October 1st and continuing through current active flu season in Howell County)

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Job Shadow Acknowledgement Checklist

(Check each item to indicate understanding)

Statement of Confidentiality

Ozarks Healthcare has a legal and ethical responsibility to safeguard the privacy of all patients and protect the confidentiality of their health and financial information. In the course of my job shadow, I may come into possession of or gain knowledge of such confidential information.

I understand that such information must be maintained in the strictest confidence and should be made available only to those who need to know. During the course of my job shadow, I will not examine, copy, or discuss information coming into my possession and will not permit any other person to do so unless it is needed for patient care, risk management, billing, maintaining or distributing records authorized by the patient.

I understand divulging information or having unauthorized possession of confidential information relating to patients, employees, or the business of Ozarks Healthcare is considered proper cause for disciplinary action.

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