My electronic signature verifies that the attached Clinical Department Orientation
Acknowledgement forms have been reconciled to the
Semester Confirmed
Request form. This signifies that every student in each clinical group at each site
has been adequately oriented to the specific Cone Health department per TJC and
CMS requirements.
School:
Electronic Signature:
Title:
Date:
Clinical Department Orientation Agreement Reconciliation Instructions
1) Collect all Clinical Department Orientation forms for your program.
2) Reconcile the Clinical Department Orientation forms with the confirmed
Request that has been sent back to you. To reconcile, ensure that you have a
Clinical Department Orientation form for each clinical group / site that has
been confirmed. Fill in the current semester and year.
3) Complete and sign the Clinical Department Orientation Reconciliation
Verification Statement and submit with all of the Clinical Department
Orientation forms. Electronic signatures are acceptable on the Verification
statement when sent from your email. Orientation forms should be scanned
and sent electronically as an attachment with the Verification statement.
4) The Reconciliation Statement and the Clinical Department Orientation forms
must be received by Staff.Education@conehealth.com prior to requesting
clinical placement for the following semester.
Submit this form with the Clinical Department Orientation Acknowledgement forms to
Staff.Education@conehealth.com
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