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CPMA Pre-Shadowing Requirements 2013-2014

Please note, all information outlined below may be referenced from its original text in the UNC
HS Shadow Student or Visitor Policy (S-10) at url:
http://www.med.unc.edu/security/hipaa/documents/Shadow%20Student%20Visitor.pdf

Please follow the steps below to register for shadowing in the UNC Health Care system. Make
sure to complete all steps at least one week before you have first scheduled to shadow.

Step 1: visit http://www.med.unc.edu/security/hipaa and click on the view link for individuals in
Group 1. Follow all the steps of the training course through completion, and make sure to fill in
your PID and personal information at the end of the module. Include the department of the
physician with whom you will be shadowing as appropriate. You should know this department,
however if you cannot find out or are unsure of this department then select other. Important:
Print two copies of your verification upon completion of reviewing the modules.
---If you ever need to print your verification form again please visit: http://www.med.unc.edu/cgi-
bin/hipaa/hipaacertificate.pl
---If you ever need to register with a different department, then go through step 1 above and at
the end of completing the module you may fill out the registration form appropriately.
---Remember you need to complete the UNC School of Medicine HIPAA training as an annual
requirement.

Step 2: visit http://unchealthcare.org/site/humanresources/careers/why/Confidentiality and
review the confidentiality agreement. Print two copies of this document. Sign your name and
signature/date where appropriate. Leave the Employee ID space blank for now. Under entity
check off UNC Hospitals and under affiliation check off both student and other with the
specificaiton Shadower. Bring this hard copy with you when you go to pick up your ID badge
(information on badges below).

Step 3: visit http://shadow.med.unc.edu/ . Enter your name and press search. Proceed to the
Registration Form. Fill out this form with the appropriate information and submit.

Step 4: verify with your shadowing host/department 48 hrs in advanced that they have
submitted the relevant information, on their end, for you to shadow. Your shadowing host must
email Volsvcs@unch.unc.edu , at least 24 hr in advance of your scheduled shadowing time,
providing them with the following information:

Name of Shadow Visitor (you)
Preceptors Name, Department and contact phone number (them)
Date(s) of the visit - beginning and ending (not to exceed 6 weeks)

IMPORTANT: It is highly recommended, and would be appropriate, for you to remind your host
(via email most likely) that they need to send this email to volunteer services as it is a fairly new
regulation in the UNC health care system.

Step 5: You may pick up your badge and turn in the signed Confidentiality Statement in the
Volunteer Services department 24 hours after they have receive the appropriate email request
from your host/preceptor. The Volunteer Services office is open M-F 8:00 to 5:00 and is located
on the ground floor of the Memorial Hospital. Be sure to pick your badge up before you go to
shadow and make sure to bring your HIPPA print-off with you as well.

Step 6: Enjoy your shadowing experience!!!!

Feel free to navigate the url: http://www.unchealthcare.org/site/volunteers/Shadow.html in
search of information that may answer your basic questions.
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The stuuent acknowleuges that by accepting the mentoi assignment, he oi she will be
solely iesponsible foi hishei conuuct. The stuuent unueistanus that the Caiolina Pie-Neu
Association, CPNA, lacks the powei to supeivise, contiol oi otheiwise limit the conuuct of
the stuuent uuiing the shauowing peiiou with the assigneu mentoi. The stuuent is
iesponsible foi theii own conuuct, anu they aie expecteu to behave in a piofessional
mannei.
In auuition, it is the policy of CPNA that the stuuents shall iespect anu pieseive the piivacy
anu confiuentiality of patient anu peisonnel infoimation. violations of this policy incluue,
but aie not limiteu to:
accessing infoimation that is not within the scope of youi job;
misusing, uisclosing without piopei authoiization, oi alteiing patient oi peisonnel
infoimation;
uisclosing anothei peison youi sign-on coue anu passwoiu foi accessing electionic
oi computeiizeu iecoius;
using anothei peison's sign-on coue anu passwoiu foi accessing electionic anu
computeiizeu iecoius;
leaving a secuieu application unattenueu while signeu on; anu
attempting to access a secuieu application without piopei authoiization.

0NC Bospitals anu othei hospitals oi clinics may iequiie that each stuuent sign a
confiuentiality statement.
By signing below, you agiee to the above teims anu conuitions.

________________________________ ________________________
StuuentNembei's Name (Piint) Stuuent's PIB

________________________________ ________________________
Stuuent's Signatuie Bate

________________________________ ________________________
CPNA Shauowing Committee Nembei Signatuie Bate

UNC Health Care System
Training Acknowledgement

Module Name _____________________________________________________



I have read and understand the intent and contents of this training module. I understand
that I am responsible for abiding by the UNC Health Care System Privacy and
Information Security Policies.

He ledo y entiendo el propsito y contenido de este mdulo de adiestramiento. Entiendo
que es mi responsabilidad de cumplir con las Normas de Privacidad y con las Normas de
Seguridad de Informacin en General de UNC Health Care System.

Signature/Firma: _______________________________ Date/Fecha: _____________

Print Name/Nombre escrito: _____________________________________
First Middle Initial and Last/Nombre, segundo nombre y apellido

Department/Departamento: __________________









Name:
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