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https://www.childrensomaha.org/staff-portal/2021-annual-medical-advanced-practice-staff-regulatory-requirements/
https://www.childrensomaha.org/staff-portal/2021-annual-medical-advanced-practice-staff-regulatory-requirements/

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Home Staff Portal 2021 Annual Medical & Advanced Practice Staff Regulatory Requirements

2021 Annual Medical & Advanced Practice Staff Regulatory Requirements

Notice: form will not work on Internet Explorer 11. Please use a Chrome, Firefox, or Edge browser.

I have read and will comply with the Children's Hospital & Medical Center Annual Mandatory Review packet.*
Annual Mandatory Review packet.
- Yes, I understand
I agree to comply with Nebraska regulations regarding the conditions requiring individual monitoring of external and internal occupational radiation dose (Title 180 NAC 4-022), as well as Children's policy "ALARA program for radiation exposure". I understand these regulations are available for review on the Nebraska Department of Health and Human Services website, and that all Children's policies are available on the employee intranet. I understand that if it is determined I am required to wear a radiation exposure monitoring badge by Children's, that it is my responsibility and requirement that I wear the badge correctly and at all times when working with or near a source of occupational radiation exposure.*
"ALARA Program for Radiation Exposure"
- Yes, I understand
I am a MD or PA that will operate fluoroscopy units.*
- Yes
- No
I have read and reviewed the information on Fluroscopy Radiation Saftey and Risks.
Fluroscopy Radiation Saftey and Risks
- Yes, I understand
I have read and will comply with the Fire Safety portion of the Children's Hospital & Medical Center PTCR20R Policy: Surgical/Procedural Verification; Correct Patient, Correct Site, Correct Procedure and the Operating Room Fire Response Protocol.*
PTCR20R Policy
Operating Room Fire Response Protocol
- Yes, I understand
I have read and will comply with the Children's Hospital & Medical Center Laser Safety Policy and Laser Safety Education for Physicians.*
Laser Safety Policy
- Yes, I understand
I have reviewed the CLA-BSI Prevention document.*
CLA-BSI Prevention document
- Yes, I understand
I acknowledge that I have received and read a copy of the Medical Staff policy on Attending Physician Responsibilities Related to Resident Service Program.*
Medical Staff policy
- Yes, I understand
I have read and agree to abide by the Medical/Allied Health Staff Review of Infection Control Procedures.*
Medical/Allied Health Staff Review of Infection Control Procedures
- Yes, I understand
I have read and will comply with the Children's Hospital & Medical Center Confidentiality and Login ID Use Agreement.*
Confidentiality and Login ID Use Agreement
- Yes, I understand
I have read and reviewed the information on the Antimicrobial Stewardship Program.*
Antimicrobial Stewardship Program
- Yes, I understand
I acknowledge that I have been provided with informative training on the policies and procedures relating to occupational exposure to hazardous drugs. I acknowledge that failure to follow the established policies and procedures may put me at risk of exposure to hazardous medications which can lead to acute, adverse effects such as skin rashes, and chronic adverse effects including, but not limited to, adverse reproductive events such as infertility, miscarriage, or birth defects; and could result in the development of cancer, and other serious medical complications.*
United States Pharmacopeia (USP) 800
- Yes, I understand
I have read and reviewed the information on the Culture Diversity, & Inclusion*
Culture Diversity & Inclusion
- Yes, I understand
I have read and reviewed the information on the Empathic Communication.*
Empathic Communication
- Yes, I understand
Signature indicates receipt, read and understood materials and agree to abide by.*

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