Raven EMS Education Program Manual
Clinical Approval Form

Student's name:

Program name:

Course start date:

The student understands and agrees that he or she may have physical contact with patients’ skin, environment, and items that may have contact with patients. The student understands and agrees to wear all appropriate Personal Protective Equipment (PPE) to reduce the risk of disease transmission and injury.

• The student must be non-febrile for at least 24 hours prior to patient contact.
• Open skin cuts and sores must be covered.
• Artificial nails or extenders are prohibited and natural nails must be kept at least less than 1/4 inch beyond the fingertips. Fingernail polish must be free of chips.

Student’s signature:
Clear

Recommendation to start clinicals date:

All of the following has been verified and documented and the above student is recommended to proceed to starting clinical experience, field experience, and field internship as appropriate:

• Minimum classroom hour requirements for program/state have been met.
• High stakes exam and term scores are above minimum required.
• Certifications have been successfully completed (i.e. BLS).
• Overall program score is above minimum required.
• Minimum skill competencies have been met.

Lead Instructor’s signature:
Clear

Program Director’s signature:
Clear

Medical Director’s signature:
Clear

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