1. Clinical Education
  2. Clinical Education
  3. Advance Practice Provider Student Attestations

Advance Practice Provider Student Attestations

Attestations must be filled completely and returned by the appropriate school official. Attestations returned by the student, or if incomplete, will not be accepted. The attestation is a form validating the following items. If your school does not require any of the items, it is the student’s responsibility to provide the information to your school official.

  1. OIG/GSA Verification
  2. Current BLS (AHA) for all clinical rotation
  3. Current health insurance
  4. Proof of Negative TB test (within 12 months) or a Health Screen Form
  5. MMR x 2 or Positive Titer: Rubella. If titer negative, documentation of additional vaccine x 2
  6. MMR x 2 or Positive Titer: Mumps If titer negative, documentation of additional vaccine x 2.
  7. MMR x 2 or Positive Titer: Measles. If titer negative, documentation of additional vaccine x 2
  8. Varicella x 2 or Positive Titer: Chicken Pox
  9. Hepatitis B Vaccine Titer showing immunity or declination form for vaccine series signed
  10. Drug Screen Completed: 10 panel (cleared and appropriate to work in a hospital setting)
  11. Negative Background Check (cleared and appropriate to work in a hospital setting)
  12. Checked Sexual Offender Registry (for state of residency and state of clinical rotation: cleared and appropriate to work in a hospital setting)
  13. Current Influenza Vaccination received prior to starting Spring rotation
  14. Current Louisiana RN license for state of clinical rotation or practicum

Resources