School Year 2014-2015 M (863) 224-3727 Course Description and Objectives Ths course s !he !hr" # a seres o$ courses # !he Me"cal Aca"e%y& Ths course s o#e o$ !hree !o co%'le!e !he Gold Seal ocational !rogram # (eal!h )ccu'a!o#s& The course s !*o se%es!ers a#" u'o# success$ul co%'le!o# o$ !hs course !he s!u"e#! %ay rece+e 1&5 elec!+e cre"!s !o*ar"s ,ar!o* Se#or (-h School (,(S) -ra"ua!o# re.ure%e#!s& The 'r%ary 'ur'ose o$ !he course s !o 're'are !he s!u"e#! e#!er#- !he heal!h care 'ro$esso#& /'o# success$ul co%'le!o# o$ !he class roo%0 cl#cal !ra##- a#" co%%u#!y ser+ce hour re.ure%e#!s0 !he s!u"e#!s rece+e a (o%e (eal!h A"e Cer!$ca!e a#" *ll be el-ble !o !a1e !he s!a!e e2a% $or Cer!$e" Nurs#- Asss!a#!s& /'o# 'ass#- !hs s!a!e e2a%0 !he s!u"e#! *ll rece+e hs3her cer!$ca!e $or Cer!$e" Nurs#- Asss!a#! ssue" by !he S!a!e o$ 4lor"a& Rules and Regulations "andator# Re$uirements 1& Co%'le!e Course a#" 5ass 62a% $or ,asc Car"ac 7$e Su''or! 2& Co%'le!e Course a#" 5ass 62a% $or (893A8:S3Me"ca!o# 6rrors 3& Co%'le!e success$ully 40 hours o$ Cl#cal Tra##- 4& Co%'le!e 32 hours o$ Co%%u#!y Ser+ce !o !he 6l"erly 5& Co%'le!e all re.ure" lab s1ll re.ure%e#!s as ls!e" 6& Co%'le!e all class*or1 re.ure%e#!s as ls!e" 7& Ma#!a# 2&5 ;5A 8& Co%'le!e a#" 5ass C56 62a%s Grading Scale Grade %eighting <2 = 100 > A 62a%s 20? 85 = <1&< > , @uAAes 10? 80 = 84&< > C Bor1boo1 10? (re'ea! o$ course s re.ure") S1ll Tra##- 10? 70 = 7<&< > : C56 20? ,elo* 70 > 4 Class or (o%e*or1 10? Cl#cal Tra##- 20? State Certi&ied Nursing Assistant '(am )ee*
6ach s!u"e#! %us! 'ay C70&00 !o*ar" !he cos! o$ !he s!a!e e2a%0 "ue by 4ebruary 10 2015 1 CNA Syllabus 2014-2015 Student+!arent ,nitials Re$uired &or 'ach Section -----+-----Clinical .raining The Nurs#- Asss!a#! 5ro-ra% #clu"es cl#cal !ra##-& The s!u"e#! s re.ure" !o 'ar!c'a!e # !he cl#cal !ra##- 'ro-ra%& :a!es a#" !%es o$ cl#cal !ra##- *ll be ass-#e" by !he 'ro-ra% #s!ruc!or& Bhe# # !he cl#cal se!!#-0 !he s!u"e#! shall be 'ro'erly "resse"0 o# !%e0 ac! 'ro$esso#ally (D'ro$esso#alE s a! !he "scre!o# o$ !he #s!ruc!or a#"3or !he su'er+sor o$ !he cl#cal !ra##- s!e) a#" ha+e all a''ro'ra!e %a!eral a#" su''les& )!her*se0 !he s!u"e#! %ay be re%o+e" $ro% !he cl#cal !ra##- s!e a#" be u#able !o co%'le!e !he course& The ,ar!o* Se#or (-h School Co"e o$ Co#"uc! also a''les *he# ass-#e" !o cl#cal !ra##-& All s!u"e#!s # !he cl#cal !ra##- 'ro-ra% must maintain a /01 G!A average in class to participate in clinical training0 2ou 3ill be dropped &rom .he Nursing Assistant Home Health Aide !rogram i& #our G!A &alls belo3 a /01 average0 -----+-----,mmuni4ations FFFFF(e'a!!s , or "ecl#a!o# *a+er FFFFF(e'a!!s C !!er FFFFFMMG FFFFFT"a' FFFFF55: (!ubercul# s1# !es!) FFFFF9arcella FFFFF 4lu 9acc#e :ue !o !he 'o!e#!al co%%u#cable "sease e2'osure0 !he s!u"e#! %us! ha+e all %%u#Aa!o# u' !o "a!e& A .5 s6in test (55:) *ll also be re.ure" 'er cl#cal s!e re.ure%e#!s& !roo& o$ all %%u#Aa!o#s %us! be o# $le *!h !he #s!ruc!or be$ore you %ay 'ar!c'a!e # !he cl#cal !ra##- 'or!o# o$ !he 'ro-ra%& A curre#! 'hyscal (+al" !hrou-h May 2015) %us! also be o# $le 'ror !o !he cl#cal !ra##- 'or!o# o$ !he 'ro-ra%& :ea"l#eH e#" o$ $rs! <-*ee1 -ra"#- 'ero"& -----+-----Drug .esting+5ac6ground Chec6 8! s !he 'olcy o$ ,(S Me"cal a#" 5ublc Sa$e!y Aca"e%y (MA5S) !o %a#!a# a s!u"e#! bo"y $ree $ro% !he use o$ lle-al "ru-s a#" be o$ -oo" %oral charac!er& The :e'ar!%e#! o$ (eal!h re.ures a l+esca# bac1-rou#" chec1 sche"ule" !hrou-h !he Mor'ho!rus! Bebs!e& The cos! o$ !hs bac1-rou#" chec1 s a''ro2%a!ely C76&50 a#" %us! be 'a" *!h a cre"! car" or "eb! car" a! !he !%e o$ re-s!ra!o#& Also0 a 10-'a#el "ru- scree##-0 *!h a# a''ro2%a!e cos! o$ C18&000 'ror !o be-###- cl#cal !ra##- AN: u#"er !he $ollo*#- crcu%s!a#cesH 1& 5re-Cl#calH Tes! resul!s %us! be o# $le *!h !he $acl!y 'ror !o !he s!u"e#!Is e#!ry #!o !he cl#cal !ra##- area& 2 CNA Syllabus 2014-2015 2& Geaso#able Sus'co#* Bhe# !here s reaso#able sus'co# (Dreaso#able sus'co#E s a! !he "scre!o# o$ !he #s!ruc!or a#"3or su'er+sor o$ !he cl#cal !ra##- s!e) !o bele+e !ha! a s!u"e#! s us#- or has use" lle-al "ru-s& 62a%'les are as $ollo*sH a& )bser+able #c"e#! a! school or cl#cal !ra##- s!e such as "rec! obser+a!o# o$ "ru- use or !he 'hyscal sy%'!o%s or %a#$es!a!o#s o$ be#- u#"er !he #$lue#ce o$ a "ru-J b& Ab#or%al co#"uc! or erra!c beha+or *hle a! school or cl#cal !ra##- s!e or a s-#$ca#! "e!erora!o# # school or #urs#- asss!a#! 'er$or%a#ceJ c& A re'or! o$ "ru- use0 'ro+"e" by a relable a#" cre"ble sourceJ "& 6+"e#ce !ha! a# #"+"ual has !a%'ere" *!h a "ru- !es! "ur#- hs3her 're- cl#cal !es!#-J e& 8#$or%a!o# !ha! a s!u"e#! has cause"0 co#!rbu!e" !o0 or bee# #+ol+e" # a# acc"e#! *hle a! !he cl#cal !ra##- s!eJ or $& 6+"e#ce !ha! a s!u"e#! has use"0 'ossesse"0 sol"0 solc!e"0 or !ra#s$erre" "ru-s *hle a! school or *hle a! cl#cals& 10-'a#el "ru- scree# %ay #clu"e bu! #o! be l%!e" !o !he $ollo*#-H 1& Ca##ab#o"s 2& Coca#e 3& A%'he!a%#es (a%'he!a%#e0 %e!ha%'he!a%#e) 4& )'a!es (hero#0 o'u%0 co"e#e0 %or'h#e0 6-MAM) 5& 5he#cycl"#e (5C5) 6& Me!ha"o#e 7& ,arb!ura!es 8& ,e#Ao"aAe'#es <& Trcyclc a#!"e'ressa#!s 10& Me!hyle#e"o2y%e!ha%'he!a%#e (M:MA or ecs!asy) Cos! o$ !he "ru- !es!#- a#" bac1-rou#" chec1 *ll be !he res'o#sbl!y o$ !he s!u"e#!& A''ro2%a!ely (C<4&50) -----+-----Attendance The s!u"e#! shoul" be 'rese#! !o all classes a#" cl#cal !ra##- ass-#%e#!s& 8# !he case o$ %sse" class !%e0 *or1 %ay be %a"e u' accor"#- !o !he 5ol1 Cou#!y School ,oar" 'olcy& 8! s !he s!u"e#!Is res'o#sbl!y !o co#!ac! !he 'ro-ra% #s!ruc!or *he# abse#!& ,& #ou miss school on a clinical training da#, #ou cannot report to #our clinical site0 8! *ll be !he s!u"e#!Is res'o#sbl!y !o %a1e u' a#y %sse" cl#cal !ra##- ass-#%e#!0 i& that option is available& You %us! re%e%ber0 sche"ules $or cl#cal !ra##- are coor"#a!e" *!h %a#y #"+"uals a#" cl#cal !ra##- s!es& There$ore0 %a1e-u' o$ a cl#cal !ra##- ass-#%e#! %ay #o! be 'ossble&
3 CNA Syllabus 2014-2015 -----+-----.ard# 8 e2'ec! all s!u"e#!s !o be o# !%e a#" # !her a''ro'ra!e sea!s *he# !he !ar"y bell r#-s& 8$ !he s!u"e#! s la!e $or cl#cal !ra##-0 *e !rea! ! !he sa%e as be#- la!e $or a Kob& 4ollo* !he 'olces a#" 'roce"ures $or !he cl#cal !ra##- s!e a#" %%e"a!ely co#!ac! !he cl#cal #s!ruc!or0 prior to the time to report& -----+-----Disciplinar# actions 5are#! or -uar"a# co#!ac! s a# o'!o# o'e# !o !he #s!ruc!or a! a#y !%e& 8$ 'ossble0 !he #s!ruc!or *ll ha+e a s!u"e#!3!eacher "scusso# be$ore #+ol+#- 'are#!s3-uar"a#s& 8$ a solu!o# ca##o! be a-ree" !o0 'are#!s3-uar"a#s *ll be #+ol+e"& 8$ !he #$rac!o# s se+ere e#ou-h (Dse+ere e#ou-hE s a! !he "scre!o# o$ !he #s!ruc!or a#"3or su'er+sor a! !he cl#cal !ra##- s!e)0 school a"%#s!ra!o# *ll be #+ol+e" a#" you %ay be "ro''e" $ro% !he Nurs#- Asss!a#! = (o%e (eal!h A"e 5ro-ra%& 8$ you are "ro''e" $ro% !he 'ro-ra%0 you *ll #o! be allo*e" !o !a1e your s!a!e e2a% $or Cer!$e" Nurs#- Asss!a#! !hrou-h ,ar!o* Se#or (-h School Nurs#- Asss!a#! 5ro-ra% -----+-----'valuation %ritten unit tests %ay be -+e# a! !he co%'le!o# o$ each u#!& These !es!s %ay #clu"e .ues!o#s $ro% !he !e2!boo10 ho%e*or1 a#" %a!eral co+ere" "ur#- class !%e& 8# a""!o#0 Clinical !ractice '(ams 7C!'8s9 *ll be a"%#s!ere" !hrou-hou! !he 'ro-ra%& The C56 *ll be a 'rac!cal (ha#"s-o#) e2a% o$ cl#cal s1lls !au-h! # !he #urs#- asss!a#! lab& 6ach C56 *ll co#ss! o$ !*o !o !hree ra#"o% s1lls& The s!u"e#! %us! 'ass all C56Is # or"er !o a!!e#" cl#cal !ra##-& 8$ !he s!u"e#! $als a C560 !he s!u"e#! *ll ha+e !he o'!o# o$ re!a1#- !he C56 !o #clu"e !he s1ll(s) $ale" a#" !*o a""!o#al s1lls& 8$ !he s!u"e#! $als !he seco#" a!!e%'!0 !he s!u"e#! *ll #o! be allo*e" !o a!!e#" cl#cal !ra##- a#" *ll be u#able !o co%'le!e !he 'ro-ra%& The s!u"e#! *ll #o! be allo*e" !o !a1e !he s!a!e e2a% $or Cer!$e" Nurs#- Asss!a#! !hrou-h ,ar!o* Se#or (-h School Nurs#- Asss!a#! 5ro-ra%& -----+-----Home3or6 and Assignments S!u"e#!s *ll be -+e# ho%e*or1 a#" ou! o$ class ass-#%e#!s& Theses ass-#%e#!s shall be !ur#e" # a! !he ass-#e" !%e& All *or1 %us! be sub%!!e" # a 'ro$esso#al %a##er& Class "aterial ,#"er = 2 #ch0 :+"ers0 No!eboo1 'a'er0 5e#- blac1 #1, 4lash "r+e 4 CNA Syllabus 2014-2015 -----+-----S6ills :ab Ma#y s1lls *ll be !au-h! # !he #urs#- asss!a#! lab "ur#- !he $rs! se%es!er !o 're'are !he s!u"e#! $or cl#cal !ra##-& 6ach s!u"e#! %us! be chec1e" o$$ o# each s1ll a#" 'ass Clinical !ractice '(ams 7C!'8s9 !es!#- 'ror !o a!!e#"#- !he cl#cal !ra##-& The s1lls *ll be "e%o#s!ra!e" by !he #s!ruc!or& A$!er !he "e%o#s!ra!o#0 !he s!u"e#! *ll 'rac!ce !he s1ll u#!l 'ro$ce#!& The s!u"e#! %ay !he# re.ues! !o be !es!e" $or co%'e!e#cy o# !he s1ll& 8$ 'ro$ce#!0 !he #s!ruc!or *ll s-# a#" "a!e !he s1ll shee!& 8$ u#success$ul0 !he s!u"e#! *ll be re.ure" !o 'rac!ce a#" !he# be !es!e" a-a# $or co%'e!e#cy& A""!o#al asss!a#ce s a+alable& See your #s!ruc!or $or !%es& 8! s !he s!u"e#!Is res'o#sbl!y !o 1ee' !he s1ll shee!s # !he s!u"e#! b#"er& 8$ !he s1ll shee! s %ss#- or #o! s-#e"0 !he s!u"e#! *ll #o! be -+e# cre"! $or co%'le!#- !ha! s1ll a#" *ll #o! be able !o re'or! !o !he cl#cal !ra##- s!e& ---FF3FFFFFClinical .raining Re$uired Documentation Re$uired 'ror !o Cl#cal Tra##- Me"cal 62a%#a!o# ('hyscal) #o %ore !ha# a year ol"0 +al" !hrou-h May 20150 *!h curre#! %%u#Aa!o# recor" 55: (chec1 *!h your #s!ruc!or $or "a!e re.ure") Me"cal Trea!%e#! Au!horAa!o# 4or% ,la#1e! 4el" Tr' 5er%sso# 4or% Gules3re-ula!o# a#" 5olces $or%-s-#e" Co'y o$ :r+ers 7ce#se Co'y o$ Socal Secur!y Car" Co'y o$ C5G Car" :scusso# *!h 'are#!3-uar"a# :ru- !es!#- resul!s = 'er $acl!es re.ues! ,ac1-rou#" chec1 = 'er $acl!es re.ues! STB !ra##- a-ree%e#! A$$"a+! o$ ;oo" Moral Charac!er -----+-----Clinical .raining ;ni&orm !olic# !urpose 1& 8"e#!$es you !o !he 'ublc a#" hos'!al s!a$$ as a s!u"e#! 1& 5rese#!s a 'ro$esso#al a''eara#ce 2& 5re+e#!s 'ossble cross co#!a%#a!o# by se'ara!#- s!ree! clo!hes $ro% *or1 clo!hes& Scrubs = Goyal ,lue *!h ,(S Me"cal Aca"e%y 7o-o Bh!e or blac1 a!hle!c or #urs#- shoes Bh!e or blac1 soc1s (%us! %a!ch shoe color) Ba!ch *!h seco#" ha#" Na%e ,a"-e 5e# = ,lac1 8#1 5 CNA Syllabus 2014-2015 /#$or%s %us! be *or# !o all cl#cal !ra##-& The u#$or% 'olcy *ll be s!rc!ly e#$orce"& 4alure !o a''ear # u#$or% *ll resul! # "s%ssal $ro% !he cl#cal !ra##- s!e a#" a# abse#ce recor"e"& (ea" co+er#-s o$ a#y 1#" are #o! allo*e"& Lac1e!s a#" s*ea!ers are #o! !o be *or# # !he cl#cal !ra##- s!e& :ur#- col" *ea!her0 !he s!u"e#! %ay *ear a *h!e or blac1 lo#- slee+e" shr! (%us! %a!ch shoe color) u#"er !he scrub !o' or a %a!ch#- royal blue scrub Kac1e!& A +are!y o$ u#$or% s!yles are a+alable& S!u"e#!s %ay choose !her o*# u#$or% +e#"or& -----+-----Classroom ;ni&orm polic# Scrubs = Goyal ,lue or ,:/Is = Na+y ,lue a#" Goyal ,lue 5olo *!h ,(S Me"cal35ublc Ser+ce Aca"e%y 7o-o& Na+y ,lue :c1es *ll also be acce'!e"& Close Toe" Shoes /#$or%s %us! be *or# !o all 'ro-ra% $u#c!o#s u#less o!her*se #$or%e"& The u#$or% %us! be *or# !o class e+ery "ay !he s!u"e#! has a MA5S Aca"e%y class& The u#$or% co"e *ll be s!rc!ly e#$orce"& (ea" co+er#-s o$ a#y 1#" are #o! allo*e"& A +are!y o$ u#$or% s!yles are a+alable& S!u"e#!s %ay choose !her o*# u#$or% +e#"or&
------+------ Clinical .raining H#giene, Hair, <e3elr#, )ingernails, .attoos, !iercings Bhle a! !he cl#cal !ra##- s!e0 s!u"e#!s %us! be *ell -roo%e" a#" har %us! be abo+e !he collar& 7o#- har %us! be #ea!ly cl''e" !o !he bac1 o$ !he hea" *!h a #eu!ral colore" cl'& 62!re%e or "s!rac!#- (De2!re%e or "s!rac!#-E s a! !he "scre!o# o$ !he #s!ruc!or) har s!yles or color *ll #o! be allo*e"& /#$or%s *ll be #ea! a#" $ree o$ *r#1les& Shoes *ll be clea# a#" 'olshe"& Shoe laces *ll be !e" securely a#" soc1s %us! be *or#& Ma1e-u' *ll be a! a %#%u%& 5er$u%e0 colo-#e0 $ra-ra#ce" lo!o#s0 e!c& are NO. !o be *or#& )#e se! o$ s!u" !y'e earr#-s %ay be *or#& )#e r#- 'er ha#" s allo*e"& No ar!$cal $#-er#als o$ a#y 1#" *ll be allo*e"& You %us! 1ee' your $#-er#als clea# a#" #o lo#-er !ha# !he e#" o$ your $#-er& 4#-er#als %ay be 'a#!e" a 'ale #eu!ral color or clear& Ta!!oos %ay #o! be +sble& 9sble bo"y 'erc#- Ke*elry0 o!her !ha# ears0 (#clu"#- oral 'erc#-s) s #o! allo*e"& FFFFF3FFFFFClinical .raining and Communit# Service 20 hours = 62!e#"e" Care 4acl!y 20 hours = Acu!e Care 4acl!y 32 hours o$ co%%u#!y ser+ce !o !he el"erly = (o%e (eal!h A"e -----+-----Clinical .raining !olicies and !rocedures Bhe# # !he cl#cal se!!#-0 !he s!u"e#! shall be 'ro'erly "resse"0 o# !%e0 ac! 'ro$esso#ally (D'ro$esso#alE a! !he "scre!o# o$ !he #s!ruc!or a#"3or su'er+sor o$ !he cl#cal !ra##- s!e) a#" ha+e all a''ro'ra!e %a!eral a#" su''les& The #urs#- asss!a#! s!u"e#! *ll re%a# # u#$or% a! all !%es& A#y $oo"3be+era-e # !he 'a!e#! care area s 'rohb!e"& 6 CNA Syllabus 2014-2015 S!u"e#!s *ll #o! a''ear $or cl#cal sesso# u#"er !he #$lue#ce o$ alcohol or o!her subs!a#ces& (a +ola!o# *ll resul! # %%e"a!e "s%ssal $ro% 'ro-ra%)& A#y #Kury rece+e" "ur#- cl#cal !ra##- shall be re'or!e" !o !he #s!ruc!or %%e"a!ely& :ur#- cl#cal !ra##-0 s!u"e#!s %ay use cell 'ho#es o#ly !o co#!ac! !he #s!ruc!or& Cell 'ho#es shall be +sble # the brea6 room or bathroom onl#& 5erso#al calls are !o be %a"e "ur#- brea1 !%e o#ly a#" # !he brea1 roo% o#ly& Cell 'ho#es are !o be o# sle#! or +bra!e& An# +ola!o# o$ !he abo+e %ay resul! # re%o+al $ro% !he 'ro-ra% a#" $ re%o+e"0 you *ll #o! be allo*e" !o !a1e !he s!a!e e2a% $or Cer!$e" Nurs#- Asss!a#! !hrou-h ,ar!o* Se#or (-h School Nurs#- Asss!a#! 5ro-ra%& -----+-----Clinical .raining Documentation Re$uirements The ,(S #urs#- asss!a#! 'ro-ra% %us! be able !o +er$y !ha! s!u"e#!s ha+e %e! cer!a# e"uca!o#al s!a#"ar"s $or co%'le!o# o$ !he course& There$ore0 !he $ollo*#- "ocu%e#!a!o# s re.ure"H Clinical .raining 'valuation Reports These $or%(s) are !o be co%'le!e" by !he 'rece'!or each cl#cal "ay& These $or%(s) *ll be !ur#e" # !o !he #s!ruc!or by !he s!u"e#! a! !he e#" o$ each cl#cal !ra##- "ay "ur#- 'os! cl#cal co#$ere#ce& )#ce -ra"e"0 !he e+alua!o# $or% *ll be re!ur#e" !o !he s!u"e#! !o be 'lace" # !he s!u"e#!Is b#"er& ,t is the responsibilit# o& the Nursing Assistant student to complete and submit all &orms and reports0 -----+------Removal o& Student &rom Clinical .raining Site The s!u"e#! %ay be re%o+e" $ro% !he cl#cal !ra##- s!e a! a#y !%e $0 a! !he "scre!o# o$ !he #s!ruc!or a#"3or su'er+sor o$ !he cl#cal !ra##- s!e0 !he ac!o#s o$ !he s!u"e#! %ay # a#y *ay co%'ro%se 'a!e#! care0 co%'ro%se !he rela!o#sh' be!*ee# !he school a#" cl#cal !ra##- s!e or co#!rbu!e !o a# u#sa$e e#+ro#%e#!& A s!u"e#! *!h"ra*# $ro% !he cl#cal !ra##- %ay 'ursue -re+a#ce 'roce"ures& (o*e+er0 !he s!u"e#! %ay #o! re!ur# !o !he cl#cal areas "ur#- !he #!er% a#" *ll #o! rece+e cre"! $or !he cl#cal& The $ollo*#- 'erso#s %ay as1 !he s!u"e#! !o lea+e !he cl#cal !ra##- s!e& Nurs#- Asss!a#! = (o%e (eal!h A"e 8#s!ruc!or 4acl!y a"%#s!ra!or (or "es-#ee)& 7 CNA Syllabus 2014-2015 -----+------5arto3 Senior High School "edical+!ublic Service Academ# Core alues and '(pected 5ehaviors* A! ,(S0 *e !each s!u"e#!s !o 'ro+"e !he bes! heal!hcare 'ossble& Be ache+e !hs !hrou-h ha+#- a $ou#"a!o# o$ sol" +alues a#" e2'ec!e" beha+ors& CAR' =, thought&ull# serve the needs o& others0= 8 'ro+"e $or !he 'hyscal0 e%o!o#al0 a#" s'r!ual #ee"s o$ %y 'a!e#!s a#" !her $a%les& 8 le#" a hel'#- ha#"& 8 ac!+ely ls!e#& 8 see1 a#" +alue "$$ere#! "eas& S.'%ARDSH,! =, e&&ectivel# use resources to best serve the health care needs o& the communit#0= 8 !a1e care o$ school3hos'!al 'ro'er!y a#" e.u'%e#!& 8 use %y !%e0 !ale#!s0 a#" su''les *sely& 8 a% a# a%bassa"or o$ ,(S # a#" ou! o$ cl#cal !ra##-& 8 +olu#!eer !o ser+e o!hers a#" !he co%%u#!y& ,N.'GR,.2 =, am sincere in doing the right thing0= 8 a% ho#es!& 8 a% $ar& 8 a% $or-+#-& 8 a% !rus!#-& >;A:,.2 =, pursue the highest standards o& care and sa&et#0= 8 s!u"y a#" 'rac!ce s1lls& 8 CNA Syllabus 2014-2015 8 cha#-e !o %'ro+e .ual!y a#" ser+ce& 8 1ee' e+eryo#e sa$e& 8 e2cee" !he e2'ec!a!o#s o$ %y !eachers a#" 'a!e#!s& ACCO;N.A5,:,.2 =, have un3avering commitment to m# per&ormance and , am responsible &or m# o3n actions0 8 1#o* a#" "o *ha! s e2'ec!e"& 8 as1 $or *ha! 8 #ee"& 8 *or1 *ell *!h a#" !h#1 o$ o!hers be$ore 8 ac!& 8 bala#ce %y l$e # a#" ou! o$ school& CO;R.'S2 =, am 6ind and polite in all interactions0= 8 al*ays #!ro"uce %ysel$& 8 say M'leaseM a#" M!ha#1 you&M 8 use res'ec!$ul la#-ua-e a#" co%%u#ca!o#& 8 !rea! o!hers *!h "-#!y a#" res'ec! -----+----- Ac6no3ledgement Ths syllabus has bee# crea!e" as a -u"e& (o*e+er0 all #$or%a!o# s subject to change as #ee"e"& A#y cha#-es *ll be a##ou#ce" # class& A# a!!e%'! has bee# %a"e !o co+er !he %aKor as'ec!s o$ !he course a#" !he e2'ec!a!o#s o$ !he s!u"e#!& < CNA Syllabus 2014-2015 Bartow Medical and Fire Academy
NAME: _________________________________________________ Period______________________ FOR PROGRAM OFFICE USE ONLY 1. STUDENT INFORMATION 2. FREE FROM ADDICTION, MENTAL, OR PHYSICAL DISEASE OR DEFFECT 3. COPY OF DRIVERS LICENSE, CPR CARD & SS CARD 4. COMPLIANCE AGREEMENT 5. SIGN AND PROVIDE COPY OF INSURANCE 6. PHYSICAL EXAM 7. IMMUNIATION SCHEDULE !. AFFIDAVIT OF GOOD MORAL CHARACTER ". ###### PCS$ MEDICAL TREATMENT AUTHORIATION FORM 1%.###### PCS$ $LAN&ET FIELD TRIP FORM
11.###### 1% PANEL DRUG SCREEN $AC&GROUND CHEC& PERMISSION FORM AND RESULTS
10 CNA Syllabus 2014-2015 Bartow Medical and Fire Academy STUENT INFORMATION PLEASE PRINT NAME' (LAST) (FIRST) ################### ADDRESS' ######################################################### CITY' #### STATE' IP CODE' ############# HOME PHONE' CELL* ########################### SOCIAL SECURITY * + + SEX' M F AGE' ############# EMAIL' ############################################################### PARENTS NAME' ###################################################### ADDRESS' ######################################################### CITY' #### STATE' IP CODE' ############# EMAIL' ############################################################### HOME PHONE' ################################# CELL PHONE' ################################## O,-./ 01,230,.4 567 0/. 283693.: 28 471- 04 ;66,<099, <08:, .,1. #################################################################################### #################################################################################### 11 CNA Syllabus 2014-2015 Bartow Medical and Fire Academy STATEMENT OF FREEOM FROM AICTION OF RUGS! MENTAL OR P"YSICAL ISEASE AN#OR EFECT T"AT MAY IMPAIR MY ABILITY TO PERFORM AS A NURSING ASSISTANT STUENT$ I UNDERSTAND THAT AT ANY TIME MY INSTRUCTORS AND OR PRECEPTORS MAY AS& ME TO TA&E A RANDOM DRUG TEST. I FURTHER UNDERSTAND I AM RE=UIRED TO SU$MITT TO A 1% PANEL DRUG SCREENING AND LEVEL II $AC&GROUND CHEC& SET UP $Y MY INSTRUCTOR THROUGH THE POL& COUNTY SCHOOL$OARD AND MAY $E RESPONSI$LE FOR THE COST. I, HERE$Y S>EAR THAT' PRINT A) I AM FREE FROM ADDICTION TO ALCOHOL AND?OR ANY CONTROLLED SU$STANCE. $) I AM FREE FROM ANY PHYSICAL AND?OR MENTAL DEFECT OR DISEASE THAT MIGHT IMPAIR MY A$ILITY TO PERFORM AS A NURSING ASSISTANT STUDENT. ############ APPLICANT SIGNATURE DATE P./4680995 @86A8 6/ ,5B. 6; 2:.8,2;210,268 08: 87C<./'##################################### SA6/8 ,6 08: 47<41/2<.: <.;6/. C. ,-24 ####### :05 6; ##########################2%##### ############ NOTARY SIGNATURE ? SEAL DATE ######################################## ############# PARENT?GUARDIAN SIGNATURE DATE P./4680995 @86A8 6/ ,5B. 6; 2:.8,2;210,268 08: 87C<./' ##################################### 12 CNA Syllabus 2014-2015 SA6/8 ,6 08: 47<41/2<.: <.;6/. C. ,-24 ####### :05 6; ##########################2%##### ########################################## ############# NOTARY SIGNATURE?SEAL DATE Bartow Medical and Fire Academy ATTACH A COPY OF YOUR DRIVERS LICENSE OR FLORIDA I.D. CARD HERE: COPY OF SOCIAL SECURITY CARD HERE: 13 CNA Syllabus 2014-2015 COPY OF CPR CARD HERE: Bartow Medical and Fire Academy COMPLIANCE AGREEMENT% THIS AGREEMENT IS RE=UIRED TO INSURE THAT ALL STUDENTS HAVE $EEN INFORMED OF CERTAIN RIGHTS THE STUDENT IS ENTITLED TO, ACCORDING TO STANDARD POL& COUNTY SCHOOL $OARD POLICY. I , HERE$Y S>EAR THAT' I HAVE READ THE SYLLA$US?O$DECTIVES MANUAL AND HAVE O$TAINED A CURRENT STUDENT HAND$OO& AND HAVE READ ALL SECTIONS, INCLUDING $UT NOT LIMITED T%' STUDENTS RIGHTS AND RESPONSI$ILITIES DUE PROCESS HEALTH SERVICES CLASS ATTENDANCE AND A$SENCES STUDENT CONDUCT DISCIPLINE, AND DUE PROCESS. I UNDERSTAND AND AGREE TO COMPLY >ITH THE POLICIES, RULES, AND REGULATIONS IN $OTH PU$LICATIONS. I FURTHER UNDERSTAND THAT IF I FAIL TO MEET THE RE=UIREMENTS OF THE $ARTO> SENIOR HIGH SCHOOL MEDICAL AND FIRE ACADEMY NURSING ASSISTANT PROGRAM, I >ILL $E DENIED CREDIT FOR THE CLASS AND AN EFF >ILL $E ENTERED ON MY HIGH SCHOOL TRANSCRIPT. ############ APPLICANT SIGNATURE DATE P./4680995 @86A8 6/ ,5B. 6; 2:.8,2;210,268 08: 87C<./'##################################### SA6/8 ,6 08: 47<41/2<.: <.;6/. C. ,-24 ####### :05 6; ##########################2%##### ############ NOTARY SIGNATURE ? SEAL DATE ######################################## ############# PARENT?GUARDIAN SIGNATURE DATE 14 CNA Syllabus 2014-2015 P./4680995 @86A8 6/ ,5B. 6; 2:.8,2;210,268 08: 87C<./' ##################################### SA6/8 ,6 08: 47<41/2<.: <.;6/. C. ,-24 ####### :05 6; ##########################2%##### ########################################## ############# NOTARY SIGNATURE?SEAL DATE Bartow Medical and Fire Academy &ERIFICATION OF STUENT "EALT" INSURANCE. PLEASE ATTACH A COPY OF YOUR CURRENT HEALTH INSURANCE OR A COPY OF THE COMPLETED APPLICATION FOR STUDENT HEALTH INSURANCE. THIS IS RE=UIRED FOR ALL STUDENTS ENROLLED IN THE NURSING ASSISTANT PROGRAM. THE SCHOOL $OARD IS NOT RESPONSI$LE FOR ANY ACCIDENTS OR INDURIES >HICH MAY OCCUR IN THE TRAINING PROGRAM. I (PARENT?GUARDIAN) PRINT UNDERSTAND THAT I AM FINANCIALLY RESPONSI$LE FOR THE TREATMENT OF ANY ACCIDENT OR ILLNESS >HICH MAY OCCUR >HILE MY CHILD IS ENGAGED IN ANY PROGRAM ACTIVITY. I HAVE A CURRENT HEALTH INSURANCE POLICY >ITH ############################# I AGREE TO MAINTAIN THIS POLICY DURING THE PROGRAM. INSURANCE COMPANY I DO NOT HAVE A CURRENT HEALTH INSURANCE POLICY. I UNDERSTAND THAT I >ILL $E COVERED $Y POL& SCHOOL$OARD INSURANCE POLICY THAT >ILL COVER ME >HILE I AM AT MY CLINICAL ONLY. ############ APPLICANT SIGNATURE DATE P./4680995 @86A8 6/ ,5B. 6; 2:.8,2;210,268 08: 87C<./'##################################### SA6/8 ,6 08: 47<41/2<.: <.;6/. C. ,-24 ####### :05 6; ##########################2%##### ############ NOTARY SIGNATURE ? SEAL DATE ######################################## ############# PARENT?GUARDIAN SIGNATURE DATE 15 CNA Syllabus 2014-2015 P./4680995 @86A8 6/ ,5B. 6; 2:.8,2;210,268 08: 87C<./' ##################################### SA6/8 ,6 08: 47<41/2<.: <.;6/. C. ,-24 ####### :05 6; ##########################2%##### ########################################## ############# NOTARY SIGNATURE?SEAL DATE ATTAC" PROOF OF INSURANCE "ERE Bartow Medical and Fire Academy PRE'ENTRANCE P"YSICAL E(AMINATION THE MEDICAL EXAMINER IS REQUIRED TO MAKE A CAREFUL PHYSICAL EXAMINATION. IMPAIRMENTS FOUND AFTER ADMISSION MAY LEAD TO THE REJECTION OF THE APPLICANT DUE TO THE INABILITY OF THE APPLICANT TO MEET PATIENT CARE RESPONSIBILITIES. THIS FORM MUST BE COMPLETED AND RETURNED ACCORDING TO FLORIDA LAW. GENERAL AUTHORITY SECTION 15, CHAPTER 731!5" AN APPLICANT MUST BE FREE FROM ANY PHYSICAL OR MEDICAL DEFECT OR DISEASE WHICH MIGHT IMPAIR THE APPLICANTS ABILITY TO ATTEND CLINICAL TRAINING. NAME" LAST FIRST MI DATE OF BIRTH" # # $$$$$$$ HEIGHT" WEIGHT" LBS. TEMPERATURE" $$$$$$$$$ BLOOD PRESSURE" # PULSE" RESPIRATION" $$$$$$$$ %WITHOUT CORRECTI&E LENSES' %WITH CORRECTI&E LENSES' D()*+,-. &()(/," R(01*" L.2*" B/*1" R(01*" L.2*" B/*1" N.+3 &()(/," R(01*" L.2*" B/*1" R(01*" L.2*" B/*1" C/4/3 &()(/," H.+3(,0" R(01*" L.2*" $$$$$$$ LIST ANY MAJOR ILLNESSES, OPERATIONS, AND HOSPITALIZATIONS (INCLUDE DATES)" $$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$ CURRENT MEDICATIONS: ____________________________________________________________________ ALLERIES: ___________________________________________________________________ FAMILY HISTORY: ______________________________________________________________
RECOMMENDATIONS: I HA&E THIS DAY GI&EN A CAREFUL EXAMINATION AND FOUND HIM # HER TO BE IN$$$$$$$$$$$$$$$ HEALTH. AFTER THIS EXAMINATION, DO YOU BELIE&E THAT THIS APPLICANTS HEALTH HISTORY AND PHYSICAL FINDINGS JUSTIFY HIM # HER TO UNDERTAKE THE CLINICAL RESPONSIBILITIES OF THE PROGRAMS AT BARTOW SENIOR MEDICAL ACADEMY? YES N/$$$$$$ PLEASE TYPE, PRINT OR STAMP THE NAME OF MEDICAL EXAMINER AND ADDRESS 17 CNA Syllabus 2014-2015
S(0,+*93. /2 P18)(-(+," D+*." $$$$$$$$ Bartow Medical and Fire Academy IMMUNI)ATION SC"EULE T-:A5 B8T(8N T(6 7AST 10 Y6AGS NAM6 3 T8T76 )4 A;6NCYH (5r#! or S!a%') :AT6 ;896NH FFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFF ,YH FFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFF S8;NAT/G6H FFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFF M6AS76S0 M/M5S0 AN: G/,677A (MMG) or 7abora!ory e+"e#ce o$ rubella 3 rubella %%u#!y& NAM6 3 T8T76 )4 A;6NCYH (5r#! or S!a%') :AT6 ;896NH FFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFF ,YH FFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFF S8;NAT/G6H FFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFF 9AG8C677A (Chc1e# 5o2) T!er 7.iter is re$uired9 NAM6 3 T8T76 )4 A;6NCYH (5r#! or S!a%') :AT6 ;896NH FFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFF ,YH FFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFF S8;NAT/G6H FFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFF R'!OR.* !OS,.,' N'GA.,' -----
:ur#- !he FF2014 - 2015FF school year& As 'are#!3-uar"a# 8 ac1#o*le"-e !he $ollo*#-H 1&School o$$cals are au!horAe" !o ob!a# e%er-e#cy %e"cal !rea!%e#! $or !hs s!u"e#! as #ecessary& 2&The School ,oar" has %a"e a+alable !o !hs s!u"e#! !he o''or!u#!y !o 'urchase s!u"e#! acc"e#! #sura#ce& 3&:ur#- !hs $el" !r'0 !ha! !he School ,oar" *ll #o! be lable $or #Kury !o !hs s!u"e#! as resul! o$ !he #e-l-e#ce0 errors0 a#" o%sso#s o$ o!hers (&e&0 char!er bus o*#ers a#" "r+ers0 or a%use%e#! 'ar1 o*#ers or *or1ers)0 !her a-e#!s0 hers0 e%'loyees or ass-#s e!her !hrou-h !her ac!o# or #ac!o#& 4&8$ your chl" !a1es 'erso#al belo#-#-s o# !hs $el" !r'0 he or she *ll be res'o#sble $or !he%& The School ,oar" acce'!s #o res'o#sbl!y $or 'erso#al !e%s0 such as *a!ches0 'urses0 %o#ey0 ca%eras0 a#" *alle!s0 e!c& 8$ a s!u"e#! s!ores 'erso#al !e%s # a loc1er a! a# a%use%e#! 'ar10 !ha! e#!!y %ay be res'o#sble $or a#y loss or "a%a-e& FFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFF FFFFFFFFFFFFFFFFF S-#a!ure o$ 'are#!3-uar"a# :a!e N)T6SH 1& T(8S ,7ANP6T 4)GM MAY ,6 /S6: 4)G TG85S )4 A S8M87AG NAT/G60 B(8C( AG6 G656AT6: :/G8N; T(6 SC())7 Y6AG& 2& 4)G A77 )/T-)4-C)/NTY TG85S0 A N)TAG8O6: M6:8CA7 TG6ATM6NT A/T()G8OAT8)N 4)GM M/ST A7S) ,6 A9A87A,76& T(6 M6:8CA7 4)GM M/ST ,6 C)M576T6: 5G8)G T) T(6 ST/:6NTQS 48GST )/T-)4-C)/NTY TG85 AN: S()/7: ,6 G6TA8N6: 4)G /S6 :/G8N; T(6 G6MA8N:6G )4 T(6 SC())7 Y6AG& All students ma# be as6ed to provide transportation to and &rom events0 Students are re$uired to sta# &or the entire event and are not permitted to leave unless the instructor &or the event has been noti&ied and the parent+guardian has given permission &or the student to leave0 !lease sign belo3 i& #ou 3ill allo3 #our student to drive to and &rom the event0 ------------------------------------------------------------ !arent+Guardian 26 @?J!anel Drug Screening The s!u"e#!s # !he CNA !rogram are re$uired !o ha+e a 10- 5a#el "ru- scree##-& The Me"cal a#" 5ublc Sa$e!y Aca"e%y has %a"e arra#-e%e#!s !o ha+e !hs !es!#- "o#e o# ca%'us $or a# a''ro2%a!e $ee o$ C18&00& Ths s a o#e-!%e o#ly "eal& 8$ you "o #o! -e! !he !es!#- "o#e a! !hs !%e0 ! *ll be u' !o you !o ha+e !he !es!#- "o#e by !he "ea"l#e -+e#& S!u"e#!s are #o! allo*e" !o -o !o cl#cal !ra##- *!hou! !hs !es!& Students need to bring this paper signed b# a parent or guardian and a driver8s license, )lorida ,D card, or !assport &or this test0 2ou must also bring #our social securit# card, i& #ou do not 6no3 the number0 .esting 3ill ta6e place in the Nursing Assistant Class and :ab0 8 a% -+#- !he 5ol1 Cou#!y School ,oar" 'er%sso# !o !es! %y s!u"e#!& S!u"e#! Na%eHFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFF S!u"e#! S-#a!ureHFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFF 5are#! Na%eHFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFF 5are#! S-#a!ureHFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFF 5lease "eclare $ you are !a1#- a#y 'rescrbe" or o+er !he cou#!er %e"ca!o#sHFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFF FFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFF FFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFF FFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFF FFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFF FFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFF FFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFF 27