• Affiliation Agreement Request Form
• Out of Service Area Affiliation Data: Word | PDF

• Medical Clearance Form (Return to Clinical)

• HIPAA Training Module and Test
• HIPAA Breach Notification Process
• HIPAA Clinical Event Notification

• Master Attestation Form
• Attestation Form (Diagnostics and Therapeutics, Pharmacy, and Imaging only)
• Attestation Form and Pre-Placement Requirements (OTA/PTA Rehabilitation Services only)
• Badge and Parking Directions (updated 10/2023)
• Off-Site Parking – Hyde Park Baptist Church (updated 10/2023)
• COMPASS Access Agreement for Faculty
• COMPASS Access Agreement for Students
• COMPASS Training (MyLearning) Form (Faculty only)
• Pre-placement Requirements Modules

• Guidelines for Imaging Students
• Visitor or Student Confidentiality Agreement

• Clinical Rotation Attestation Letter (updated 10/2023)
• Education Affiliation Agreement Checklist
• Allied Health Student Orientation Instructions
• Online Orientation
• Network System User Agreement
• Nursing Student Orientation Acknowledgement of Completion
• HIPAA Training Acknowledgement
• Student Substance Abuse Policy

• Clinical Placement Instructions
• Clinical Rotation Checklist (updated December 13, 2022)
• HIPAA Training Acknowledgement
• Student/Independent Contractor Confidentiality Agreement
• College Student Compliance Safety Quiz
• Orientation Guide (updated 10/2023)
• Orientation Packet

• Online Orientation Process
• Completion of CSR Orientation Certificate for Faculty (must review all orientation information below prior to filling out the certificate. Orientation information can be found on the Christus website here.
• Completion of CSR Orientation Certificate for Students (must review all orientation information below prior to filling out the certificate. Orientation information can be found on the Christus website here.
• Notification of Experience – Single Student
• Notification of Experience – Multiple Students
• EPIC Computer Access Request Form
• Computer Agreement/Confidentiality
• Vaccination Verification Ancillary
• Immunization Exemption Form
• Verification Form

Updated: October 2023

• Student Checklist (updated 10/2023)
• Clinical Affiliation Contract Exhibits A-D (updated 10/2023)
• Environment of Care (EOC) & Emergency Response (updated 10/2023)
• Infection Control & Prevention (updated 10/2023)

For Ben White location only:
Hospital Emergency Codes

• Accudose Security Agreement
• Attestation Form (updated March 31, 2023)
• Faculty Orientation Manual (updated March 31, 2023)
• Faculty Orientation Manual Attestation Form
• Student Orientation Manual (updated March 31, 2023)
• Student Orientation Manual Attestation Form
• Mandatory Orientation Module and Post Test
• Statement of Responsibility
• Meditech Access Request Form and Confidentiality & Security Agreement
• ICARE My Commitment to Our Values Form
• Substance Use in the Workplace Acknowledgment (updated Fall 2022)
• Fit Test Verification and Attestation Form
• Flu Vaccine Verification and Attestation Form (updated 09/2024)
• USP <800>: Safe Handling of Hazardous Drugs Module and Post Test
• Bridging the Gap Modules (Complete Modules 1-4 only)
• St. David’s Ambulatory Student Packet
• COVID-19 Self-Screening Attestation Form (updated 10/2023)