Nursing Assistant - Syllabus and Objectives Updated May 2014

CNA Syllabus 2014-2015
Nursing Assistant Home Health Aide Susan Hill, RN

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
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 $acl!y 'ror !o !he s!u"e#!Is e#!ry
#!o !he cl#cal !ra##- area&
2
2& Geaso#able Sus'co#* Bhe# !here s reaso#able sus'co# (Dreaso#able sus'co#E s
a! !he "scre!o# o$ !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
-----+-----.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
-----+-----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 $ro% *or1 clo!hes&
Scrubs = Goyal ,lue *!h ,(S Me"cal Aca"e%y 7o-o
Bh!e or blac1 a!hle!c or #urs#- shoes
Bh!e or blac1 soc1s (%us! %a!ch shoe color)
Ba!ch *!h seco#" ha#"
Na%e ,a"-e
5e# = ,lac1 8#1
5
/#$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
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
-----+------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% $or-+#-&
8 a% !rus!#-&
>;A:,.2 =, pursue the highest standards o& care and sa&et#0=
8 s!u"y a#" 'rac!ce s1lls&
8
8 cha#-e !o %'ro+e .ual!y a#" ser+ce&
8 1ee' e+eryo#e sa$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#!&
<
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
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
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
SA6/8 ,6 08: 47<41/2<.: <.;6/. C. ,-24 ####### :05 6; ##########################2%#####
########################################## #############
NOTARY SIGNATURE?SEAL DATE
ATTACH A COPY OF YOUR DRIVERS LICENSE OR
FLORIDA I.D. CARD HERE:
COPY OF SOCIAL SECURITY CARD HERE:
13
COPY OF CPR CARD HERE:
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.
############
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%#####
############
######################################## #############
14
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%#####
########################################## #############
&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.
############
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%#####
############
######################################## #############
15
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%#####
########################################## #############
ATTAC" PROOF OF INSURANCE "ERE
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: ______________________________________________________________

NORMAL ABNORMAL NOTES ! COMMENTS
G.,.3+4 A55.+3+,-.
H.+6, N.-7, T183/(6, F+-., S-+45
N/)., +,6 S(,9).)
M/9*1 +,6 T13/+*
16
T..*1 +,6 G9:)
E+3) %I, G.,.3+4' +,6 E+3 D39:)
E8.)
C1.)*
L9,0)
H.+3*
NORMAL ABNORMAL NOTES ! COMMENTS
A;6/:.,
U55.3 E<*3.:(*(.)
L/=.3 E<*3.:(*(.)
B+-7 +,6 S5(,.
S7(,
N.93/4/0(-+4 E<+:(,+*(/,, I,-496(,0
R.24.<.)
O*1.3 +;,/3:+4(*(.) /3 .<54+,+*(/, /2 +;/>. 2(,6(,0)" $$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$
$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$

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

S(0,+*93. /2 P18)(-(+," D+*." $$$$$$$$
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&
,YH FFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFF
S8;NAT/G6H FFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFF
9AG8C677A (Chc1e# 5o2) T!er 7.iter is re$uired9
,YH FFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFF
S8;NAT/G6H FFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFF
R'!OR.* !OS,.,' N'GA.,' -----

47/ 9ACC8N6 7Re$uired prior to <anuar# /?@19
55: B8T(8N T(6 5AST T(G66 (3) M)NT(S& A5578CANTS B8T( 5)S8T896 G6S/7TS M/ST (A96 A
C(6ST N-GAY& A5578CANTS B8T( A N6;AT896 G6S/7T :) N)T G6@/8G6 A C(6ST N-GAY&
18
:AT6 )4 C(6ST N-GAYH R'!OR.* !OS,.,' N'GA.,' -----
,YH ASS'SS'D 52H FFFFFFFFFFFFFFFFFFFFFFFFF
S8;NAT/G6H S,GNA.;R'* ---FFFFFFFFFFFFFFFFFFFFFFFF
(65AT8T8S C A#!bo"y Tes!#- *!h# 'as! s2 (6) %o#!hs o$ cl#cal s!ar! "a!eH
!RO,D' CO!2 O) R'!OR.* !OS,.,' N'GA.,' ------
(65AT8T8S , S6G86S& 84 T(6 A5578CANT C())S6S N)T T) G6C6896 T(8S 8MM/N8OAT8)N0 T(6
BA896G AT T(6 ,)TT)M )4 T(8S 4)GM M/ST ,6 S8;N6:&
,YH FFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFF FFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFF
S8;NAT/G6HFFFFFFFFFFFFFFFFFFFFFFFFFFFF FFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFF

R"#"ct$on o% I&&'n$(at$on
T1() =(44 -.3*(28 *1+* I, *1. 9,6.3)(0,.6, 9,6.3)*+,6 *1. 3()7 /2 .<5/)93. +,6 5/))(;4. -/:54(-+*(/,) =1(-1 :+8
/--93 +) + 3.)94* /2 -/,*+-* =(*1 5+*(.,*) =1/ 1+>. H.5+*(*() B.
S1/946 I -/,*3+-* H.5+*(*() =1(4. +* *1. -4(,(-+4 *3+(,(,0 )(*. +) + )*96.,*, I =(44 ,/* 1/46 *1. H/)5(*+4, N93)(,0
H/:., B+3*/= S.,(/3 H(01 S-1//4 M.6(-+4 +,6 F(3. A-+6.:8 /3 *1. P/47 C/9,*8 S-1//4 B/+36 /3 +,8 /2 *1.
3.53.).,*+*(>.) 3.)5/,)(;4..
S(0,+*93." D+*." $$$$$$$$$$$$$$$$$$
THIS MAY $E O$TAINED FROM THE POL& COUNTY SCHOOL $OARD FILE $Y THE STUDENT. THE
STUDENT >ILL STILL NEED TO O$TAIN A CURRENT T$ TEST FOR THIS SCHOOL YEAR.
1<
20
Re$uirement Description

@0 .DA! T:a5H Te!a#us0 :'h!hera0 a#" 5er!usssJ !o -e! !e!a#us
*!h 'er!usss0 ! has !o ha+e bee# a! leas! 2 years s#ce
las! !e!a#us&
/0 ""R 8$ bor# a$!er 1<570 +er$ca!o# o$ MMG %%u#!y +a
"ocu%e#!a!o# o$ %%u#Aa!o# seres0 'hysca#
"ocu%e#!a!o# o$ "sease0 or !!er
A0 aricella 9er$ca!o# o$ +arcella %%u#!y +a "ocu%e#!a!o# o$
%%u#Aa!o# seres0 'hysca# "ocu%e#!a!o# o$
+arcella or sh#-les0 or !!er
B0 !!D 55: *!h# 3 %o#!hs (:ec& 2015) o$ #!al cl#cal
ass-#%e#!0 as re.ure" by 7GMC3,4:35C6MSJ ches!
N-ray $ 'os!+e 55:J 'hysca# "ocu%e#!a!o# o$
s!a!us $ CNG 'os!+e
10 Hepatitis C (e'a!!s C !!er #o %ore !ha# o#e year ol"
C0 Hepatitis 5 (e'a!!s , seres a#" !!er or s-#e" "ecl#a!o# *a+er
D0 5ac6ground chec6 Ge.ure" by 7GMC3,4:35C6MS S!u"e#!s
*ll ha+e !hs "o#e by la* e#$orce%e#! a#" resul!s
-+e# !o #s!ruc!or $or $le
E0 @? panel Drug screen Ge.ure" by 7GMC3,4:35C6MS S!u"e#!s
*ll ha+e !hs "o#e by a lab o$ !her choos#- a#"
resul!s $a2e" !o #s!ruc!or $or $le
F0 )lu accine Ge.ure" 'ror !o La#uary 2015
21
Exhibit A
Affidavit of Good Moral Character
S!a!e o$ 4lor"a Cou#!y o$ 5ol1
,64)G6 M6 !hs "ay 'erso#ally a''eare" FFFFFFFFFFFFFFFFF
Bho0 be#- "uly s*or#0 "e'oses a#" saysH 5r#!
8 hereby a!!es! !ha! 8 a% o$ -oo" %oral charac!er0 !ha! 8 ha+e #o! bee# $ou#" -ul!y o$0 re-ar"less o$ a"Ku"ca!o#0
or e#!ere" a 'lea o$ #olo co#!e#"ere or -ul!y !o0 a#y o$$e#se 'rohb!e" u#"er a#y o$ !he $ollo*#- 'ro+so#s o$ !he
4lor"a S!a!u!es or u#"er a#y s%lar s!a!u!e o$ a#o!her Kurs"c!o#H
(1) Sec!o# 415&111 rela!#- !o a"ul! abuse0 #e-lec!0 or e2'lo!a!o# o$ a-e" 'erso#s or "sable" a"ul!s&
(2) Sec!o# 782&04 rela!#- !o %ur"er
(3) Sec!o# 782&07 rela!#- !o %a#slau-h!er
(4) Sec!o# 782&071 rela!#- !o +ehcle ho%c"e
(5) Sec!o# 782&0< rela!#- !o 1ll#- a# u#bor# chl" by #Kury !o !he %o!her
(6) Sec!o# 784&011 rela!#- !o assaul!0 $ !he +c!% o$ !he o$$e#se *as a %#or
(7) Sec!o# 784&021 rela!#- !o a--ra+a!e" assaul!
(8) Sec!o# 784&03 rela!#- !o ba!!ery0 $ !he +c!% o$ !he o$$e#se *as a %#or
(<) Sec!o# 784&045 rela!#- !o a--ra+a!e" ba!!ery
(10) Sec!o# 787&01 rela!#- !o 1"#a''#-
(11) Sec!o# 787&02 rela!#- !o $alse %'rso#%e#!
(12) Sec!o# 7<4&011 rela!#- !o se2ual ba!!ery
(13) Cha'!er 7<6 rela!#- !o 'ros!!u!o#
(14) Sec!o# 7<8&02 rela!#- !o le*" a#" lasc+ous beha+or
(15) Cha'!er 800 rela!#- !o le*"#ess a#" #"ece#! e2'osure
(16) Sec!o# 806&01 rela!#- !o arso#
(17) Cha'!er 812 rela!#- !o !he$!0 robbery0 a#" rela!e" cr%es0 $ !he o$$e#se s a
4elo#y& (See 812&0140 812&0160 812&01<0 812&0810 812&130 812&1330 812&1350 812&140 812&16)
(18) Sec!o# 817&563 rela!#- !o $rau"ule#! sale o$ co#!rolle" subs!a#ces0 o#ly $ !he o$$e#se *as a $elo#y
22
(1<) Sec!o# 826&04 rela!#- !o #ces!
(20)Sec!o# 827&03 rela!#- !o a--ra+a!e" chl" abuse
(20) Sec!o# 827&05 rela!#- !o #e-l-e#! !rea!%e#! o$ chl"re#
(21) Sec!o# 827&071 rela!#- !o se2ual 'er$or%a#ce by a chl"
(22) Cha'!er 847 rela!#- !o obsce#e l!era!ure
(23) Cha'!er 8<3 rela!#- !o "ru- abuse 're+e#!o# a#" co#!rol0 o#ly $ !he o$$e#se *as a $elo#y or $ a#y o!her
'erso# #+ol+e" # !he o$$e#se *as a %#or&
8 $ur!her a!!es! !ha! 8 ha+e #o! bee# Ku"cally "e!er%#e" !o ha+e co%%!!e" abuse or #e-lec! a-a#s! a chl" as
"e$#e" # s&3<01(2) a#" (36)0 4lor"a S!a!u!esJ #or "o 8 ha+e a co#$r%e" re'or! o$ abuse0 #e-lec!0 or e2'lo!a!o# as
"e$#e" # s&415&1020 or abuse or #e-lec! as "e$#e" # s&415&503 (3)0 *hch has bee# u#co#!es!e" or u'hel" u#"er
s&415&103 or s&415&5040 4lor"a S!a!u!esJ #or ha+e 8 co%%!!e" a# ac! *hch co#s!!u!es "o%es!c +ole#ce as "e$#e"
# s&741&280 4lor"a S!a!u!es&
/#"er !he 'e#al!es o$ 'erKury0 8 "eclare !ha! 8 ha+e rea" !he $ore-o#-0 a#" !he $ac!s alle-e" are !rue !o !he bes! o$
%y 1#o*le"-e a#" bele$&
FFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFF
A$$a#!
)G
To !he bes! o$ %y 1#o*le"-e a#" bele$0 %y recor" %ay co#!a# o#e o$ !he $ore-o#- "s.ual$y#- ac!s or o$$e#ses&
A$$a#!
SB)GN T) AN: S/,SCG8,6: be$ore %e !hs "ay o$ 0 20FFF 0
,y 0 *ho s 'erso#ally 1#o*# !o %e or has
'ro"uce" 0 as "e#!$ca!o#0 a#" *ho "" !a1e a#
oa!h&
S-#a!ure o$ No!ary 5ublc - S!a!e o$ 4lor"a
23
5r#!0 Ty'e or S!a%' Na%e o$ No!ary 5ublc
24
.H' SCHOO: 5OARD O) !O:G CO;N.2
"'D,CA: .R'A."'N. A;.HOR,HA.,ON )OR"
T) B()M 8T MAY C)NC6GNH
8 !he u#"ers-#e" 'are#!3-uar"a# o$ FFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFF hereby au!horAe
a#y #ecessary %e"cal !rea!%e#! $or !hs s!u"e#! *hle 'ar!c'a!#- # $el" !r's co#"uc!e" u#"er !he
s'o#sorsh' o$ 5arto3 "edical I )ire Academ# I A:: HOSA 'vents- "ur#- !he /?@BJ/?@1--school
year a#" -uara#!ee 'ay%e#! o$ all char-es #curre" as a resul! o$ !hs %e"cal !rea!%e#!&
8N4)GMAT8)NH 5lease 5r#!
A776G;86S T) 4)):0 M6:8CAT8)N0 6TC& (8$ #o#e0 so s!a!e&) FFFFFFFFFFFFFFFFFFFFFFF
S56C8A7 M6:8CA7 C)N:8T8)NS (8$ #o#e0 so s!a!e&)FFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFF
4AM87Y 5(YS8C8AN FFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFF
)448C6 A::G6SS FFFFFFFFFFFFFFFFFFFFFFFFFFFFFF5()N6 N)FFFFFFFFFFFFFFFFFFFF
5AG6NT3;/AG:8AN NAM6FFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFF
5AG6NT3;/AG:8AN ()M6 A::G6SSFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFF
()M6 5()N6FFFFFFFFFFFFFFFFFFFFFFFFFFFB)GP 5()N6FFFFFFFFFFFFFFFFFFFFFFFF
FFFFFFFFFFFFFFFFFFFFFFFFFFFFFF FFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFF
8#sura#ce Co%'a#y0 5olcy No& or ;rou' No&
FFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFF
5AG6NT3;/AG:8AN S8;NAT/G6 :AT6
STAT6 )4 47)G8:A0 C)/NTY )4 FFFFFFFFFFFFFFFFFFFFFFFFFFFFFF
8 hereby cer!$y !ha! !he $ore-o#- *as e2ecu!e" be$ore %e !hs FFF"ay o$FFFFFFFFFFFFFFFFFFFFF20FFFF
byFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFF0 *ho s 'erso#ally 1#o*# !o %e or *ho has 'ro"uce"
FFFFFFFFFFFFFFFFFFFFFFFas "e#!$ca!o# a#" *ho "" ("" #o!) !a1e a# oa!h&
FFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFF
No!ary 5ublc0 S!a!e o$ 4lor"a
T(8S 4)GM 8S T) ,6 /S6: 4)G A77 )/T-)4-C)/NTY 4867: TG85S 6NC65T AT(76T8C ACT898T86S&
T(6 4)GM S()/7: ,6 C)M576T6: 5G8)G T) T(6 ST/:6NTIS 48GST )/T-)4-C)/NTY TG85 AN:
G6TA8N6: )N 4876 4)G T(6 G6MA8N:6G )4 T(6 SC())7 Y6AG&
25
.H' SCHOO: 5OARD O) !O:G CO;N.2
5:ANG'. ),':D .R,! !'R",SS,ON )OR"
T) B()M 8T MAY C)NC6GNH
----- FFFFFFFFFFFFFFFFFFFFFFFFFFFFF has %y 'er%sso# !o 'ar!c'a!e # all
Na%e o$ s!u"e#!
4el" !r's !o be !a1e# by ,ar!o* Se#or (-h Me"cal Aca"e%y a#" ()SA 6+e#!sFFFFF
Na%e o$ or-a#Aa!o#3-rou'

: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
27

Nursing Assistant - Syllabus and Objectives Updated May 2014

Enviado por

Dados do documento

Título original

Direitos autorais

Formatos disponíveis

Compartilhar este documento

Compartilhar ou incorporar documento

Opções de compartilhamento

Você considera este documento útil?

Este conteúdo é inapropriado?

Direitos autorais:

Formatos disponíveis

Nursing Assistant - Syllabus and Objectives Updated May 2014

Enviado por

Direitos autorais:

Formatos disponíveis

CNA Syllabus 2014-2015

Nursing Assistant Home Health Aide Susan Hill, RN

Você também pode gostar