12. Preceptorship/Externship Affidavit

Who was your Admissions Counselor?  

Students must complete the following courses in following sequence:

General Education Classes
IDS1107 Strategies for Success

Core Classes
MEA1238/1303C Medical Terminology / Medical Office Management
MEA1236 Anatomy and Physiology
MEA1290 Radiography
MEA1206C Clinical Procedures
MEA1267C Laboratory Procedures I
MEA2268C          Laboratory Procedures II
MEA2806 Externship I
MEA2807 Externship II

General Education Classes
ENC1101 English Composition I
CGS1000C            Introduction to Computers
MAT1033 Intermediate Algebra
BSC1010 General Biology
BSC1011 Advanced Biology
AML1000

American Literature
SPC1017 Speech

Clinical Requirements:
Students are responsible for locating their own clinical sites.

  • Upon Enrollment student is required to provide name and contact information for two (2) Clinical Sites which they have contact in preparation for their clinical hours:   (Please List Below)
  • Singed “Affiliation Agreement” with a clinical site allowing students the opportunity of their clinical rotation, must be received by the third week of the MEA1290 – Radiography class, prior to the Clinical Procedure MEA1206C - class start.
  • The following additional paperwork must be submitted to the Clinical Coordinator of the Medical Assisting Program at Keiser University with your signed “Affiliation Agreement”. 
    • Valid CPR Class (Basic Life Support Card), which may be acquired through the following website: www.cprtoday.com
    • Certificates for Infection Prevention, HIV/AIDS, and HIPPA , which may be acquired through the following website:  www.rn.com
    • ID and insurance card (or waiver)
    • Other required forms found within your Preceptorship Student Packet
  • The following Clinical Rotation Courses along with the required clinical hours for each course must be completed in full within the period of time allotted for each course:
    • MEA1206C - Clinical Procedures - 40 clinical hours, skill evaluation sheet, and completion of class.
    • MEA1267C - Laboratory Procedures I - 40 clinical hours, skill evaluation sheet, and completion of class.
    • MEA2268C - Laboratory Procedures II – 40 clinical hours, skill evaluation sheet, and completion of class.
    • MEA2806 - Externship I – 160 clinical hours (40/week), skill evaluation sheet, and completion of class.
    • MEA2807 - Externship II - 160 clinical hours (40/week), skill evaluation sheet, and completion of class.

Clinical Site Information
Clinical Sites: Include but limited to: Doctor Office, Hospital, Urgent-Care Centers.

1. Name of Clinical Site:
Address
   
Contact Number:
Fax Number:
Contact Person:

2. Name of Clinical Site:
Address
   
Contact Number:
Fax Number:
Contact Person:

 

Applicant Name/Electronic SignatureBy typing your name you have created an electronic signature as legally binding as your handwritten signature.


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