Clinical Manual (2017) - Great Lakes...

EMT-Basic Clinical Manual (2017)

Great Lakes EMS Academy

1001 South Division

Grand Rapids, MI 49507

Phone: 616 459 1736

www.GreatLakesEMS.com

http://www.greatlakesems.com/

1

Table of Contents

Page #

Contact Information 3

The Clinical Experience 3

Progress Table 4

FISDAP 5

Rules in the Clinical Environment 6

Clinical Obligation 6

Attendance policy 7

Clinical Site Directions and Instructions 7

Clinical Objectives 8

Clinical Uniform and Appearance Standards 9

Clinical Obligation Assurance Statement 12

Clinical Observation Forms and Patient Care Reports 14-18

2

Letter from the President

EMT Student,

EMT class is going to be fun! The most enjoyable part of class is the time you

spend in the clinical environment. When you are riding on the ambulance or

spending time in the emergency room you can get a sense of what your chosen

career is going to be like. The experiences you go through in the clinical

environment will help you learn the curriculum better.

West Michigan is an awesome place to learn from the people doing the job. You

should try to take advantage of this opportunity. We specify minimum number of

hours and minimum number of experiences. There is not set maximum number of

hours. Most of us in education know that we learn by doing. So, get out there

and do the stuff in a safe and comfortable environment.

You are responsible for your progress through the clinical phase. You will be

doing the scheduling. You will be doing the documentation. Make sure that you

are keeping everything up-to-date. Many students have dropped the ball in the

past and did not stay focused on the documentation of their clinicals. Make

sure you stay diligent with the documentation. It is an important aspect of

being successful in EMS.

I think that this is a good time for you to “play the field”. You should try to

schedule time at each of the major ambulance companies in the area and see what

you might like and not like about those companies. You can also ride with a few

different crews. Later, I will want you to attempt to stay with one crew to

build a good working relationship. Now is the time to see how different people

work in EMS.

Lastly, have fun with it! This is what you have been training for. Don’t worry

so much about mistakes. Just, get in there and take care of some patients. If

you are too timid to do some assessments or take vital signs, the preceptor will

not be able to help you with your performance.

Good Luck!

Steve Huisman

President / Owner

Great Lakes EMS Academy

3

Contact Information

Great Lakes EMS Academy 1001 South Division Grand Rapids, MI 49507 Phone: (616) 459-1736 Fax: (616) 459-2251 Amy Eichelberg, EMS I/C, Clinical Coordinator Work phone: (616) 459-1736 Email: [email protected]

Melissa Warner, EMS I/C, Director of Operations Work phone: (616) 459-1736 Cell Phone: (616) 828-7167 Email: [email protected]

The Clinical Experience All participants of an EMT-Basic Course at the Great Lakes EMS Academy must attend a certain number of hours in a

clinical setting. This time will be spent at various hospitals and ambulances in the West Michigan area. The importance

of experiential learning cannot be overstated. During the clinical exposure, it is expected that all students will conduct

themselves in a professional way and show enthusiasm towards learning.

All clinicals will be scheduled through the FISDAP. If students sign up for clinicals outside of the “system”, the time

spent at those clinicals will not count towards their clinical obligations. If a student has an emergency cancellation of a

clinical, they should call the Clinical Coordinator at the earliest possible time to advise her that they will not be able to

make their clinical obligation.

The clinical experience is a documentation intensive activity. Students are to complete:

1. Skills completed while in the clinical environment.

2. CHARTing of each patient care experience (while on the ambulance).

3. Clinical Daily Performance Records (pen-n-paper).

mailto:[email protected]

mailto:[email protected]

4

Progress Table

The student must have the immunizations and exposure control items signed off before going into the clinical

environment. The other items are to be signed off after the students shows a basic level of competency and the instructor

believes it is safe for the student to perform the skill in the clinical environment with minimal supervision.

The student’s initials contend that the student feels comfortable with the skill.

In the clinical environment, the preceptor can use this table as a reference when establishing whether a student has the

didactic and practical instruction before attempting various skills on patients.

Item Instructor’s

initials Student’s

initials Date

Immunizations

Exposure Control

AHA B.L.S.

IPS and Vita l Signs

Basic Airway and O2

Trauma Assessment / Management

Soft Tissue Injuries (bandaging)

Musculoskeletal (splinting)

Medical Assessment / Management

5

FISDAP (Clinical Scheduler)

The Great Lakes EMS Academy uses FISDAP for clinical tracking and documentation. FISDAP is the website the

students will use to:

1. Schedule their clinical experiences

2. Track their skills in lab

3. Document and track their patient encounters

How do I create a new FISDSAP account?

All Students will need to have a FISDAP account before the first day of class.

1. Once you have a FIISDAP activation code, creating an account is easy.

2. Go to the FISDASP home page, www.fisdap.net.

3. Click Create an Account.

4. Type or paste in your activation code (you get that from Melissa) and click Continue.

5. You will need to enter your billing information, then click Place Order. On the receipt page, click Create Your

Account.

6. Enter your profile information, and choose a FISDAP username and password, then click Save & Continue.

7. Read and accept the User Agreement and click Continue.

8. You’re all done! Click Continue to My FISDAP to log in and access your new account.

Scheduling Clinicals Students will be required to sign up for all their clinical obligations early in the course. Throughout the course there may

be occasions when the student will need to change the schedule, this can be done through FISDAP when thee is time to

make that change. Otherwise, the student should notify the Clinical Coordinator or the Director of the Academy

Clinical scheduling can be very difficult. It is expected that the student will sign up for clinicals in such a manner that

would avoid many schedule changes or conflicts.

All clinicals will be scheduled through FISDAP. If students sign up for clinicals outside of the “system” used to schedule

clinicals, the time spent at those clinicals will not count towards their clinical obligations.

If a student has an emergency cancellation of a clinical, they should call the Clinical Coordinator at the earliest possible

time to advise her that they will not be able to make their clinical obligation.

http://www.fisdap.net/

6

Rules in the Clinical Environment The rules listed below are set forth to assure the various clinical sites that students will be professional and will follow set

policies. Students who violate these rules can be dismissed from the Academy without prospect of reclaiming their tuition.

Many actions will warrant a verbal reprimand followed by a written reprimand and then finally dismissal (progressive

discipline). However other actions may call for immediate dismissal. These actions must be proven and substantiated by

witnesses or confession.

1. Falsifying records for time spent at clinical sites will not be tolerated.

2. An act of gross negligence in patient care during any clinical exposure.

3. Demonstrating lack of medical ethics such as disclosure of confidential information.

4. Harassing employees, patients or other individuals encountered at clinical sites. Harassment of a

threatening nature may be grounds for immediate dismissal.

5. Stealing property owned or leased by the clinical site will mean immediate dismissal and charges will

be pressed.

6. Bringing weapons to the clinical site. Again, this could be reason for immediate dismissal.

7. The use of illicit drugs or alcohol within 8 hours before a clinical experience will warrant dismissal

from the Academy

8. As a student, you will not operate any radio or drive any vehicles.

9. You must plan to ride the entire shift. The ambulance company cannot jeopardize the coverage to

return you to headquarters at your discretion.

10. Large purses and bulky items are cumbersome and cannot be accommodated in the ambulance.

11. The use of seatbelts is mandatory while the ambulance is in motion.

12. No eating, drinking, applying makeup or applying lip balm while in the patient compartment.

13. Students must comply with all clinical uniform standards. Failure to adhere to clinical uniform and

appearance standards while at a clinical is reason for immediate dismissal from the program.

14. If the patient presents a possible exposure risk, i.e. open wounds, draining lesions, or persistent cough,

the EMS student will follow appropriate infection control guidelines.

15. Students need to be very careful regarding what they post on social media regarding what they saw

while in the clinical environment. Absolutely nothing should be posted that would be referenced to a

certain patient situation. This is not only an Academy rule; it is a HIPAA violation.

Student ID Each student will have an ID badge created and distributed by the Academy. This badge will be completed and given to

the Student before clinical observation begins. This will be a picture ID with general student information to include name,

course, and student number. ID’s must be worn during each clinical experience.

Wearing uniforms to school.

From time-to-time students will wear their uniform to class. This is usually the case on the practical days (Tuesdays). When students are wearing the uniform, they are to adhere to all the clinical uniform guidelines. Hence, no tennis shoes, not brown boots, not beards (facial hair), no earrings. You must follow all the rules. Or, simply do not wear the uniform.

Clinical Obligations There is a minimal requirement for the hours a student spends in the clinical environment.

Clinical Area Hours

ALS Ambulance 36

Emergency Department 12

7

Attendance Policy for the Clinical Obligation Students must be prompt and dependable in regards to their clinical schedule. Tardiness is unacceptable. If a student

misses a clinical and does not give any notice of such conduct, they will be placed on probation for the rest of the module.

A second occurrence during that module will lead to a failing grade for the clinical obligation.

Clinical Site Directions and Instructions

Tardiness

If you will be arriving late to a clinical, do not go. You will need to reschedule.

American Medical Response (AMR) - Grand Rapids

517 South Division, Grand Rapids: 131 to Wealthy, East on Wealthy to Division, South on Division to Logon, West on

Logon, immediate Left into AMR Back Parking Lot. Go to back door and pick up phone, this will ring into dispatch. Tell

them you are there for a Clinical and they will let you in and direct you.

American Medical Response (AMR) - Holland

2629 N. Park Drive, Holland: In Walmart parking lot, at James and 131. Go to the door and knock or use bell.

Life EMS

1275 Cedar NE, Grand Rapids: 196 to Fuller Ave, north on Fuller to Cedar, east on Cedar to Life EMS on Left. Park in

parking lot or in parking lot next door. Go to front door or back door if after business hours.

*For other ambulance service instructions, contact Melissa or Amy

Rural Service

*Students participating in clinicals at a rural or slow service, i.e. 24-hour shifts, must have 5 patient contacts to qualify

for a 12-hour shift.

Saint Mary’s Hospital Emergency Room (Mercy Health Services):

200 Jefferson, SE, Grand Rapids: Park in visitors’ lot (there may be a fee for parking) go to emergency room entrance and

check in at registration or security desk.

Holland Hospital Emergency Room:

602 Michigan Ave, Holland: Go to emergency department entrance and check in at registration or security desk

8

Clinical Objectives Ambulance

Perform patient assessment including developing relevant medical history and conducting a physical

examination. The assessment, at a minimum, should include taking and recording vital signs, and auscultation

of lung sounds.

Assist in and review the treatment of patients, to include:

1. Monitoring vital signs 5. Splinting

2. Oxygen administration 6. Extrication and backboarding

3. Bleeding control 7. Basic Airway management

4. Ventilation 8. CPR

Observe the Paramedics during management of various cases.

Observe the Paramedics during various patient, family, and public interactions.

Observe the interaction between the pre-hospital providers and the Nursing staff at local Emergency Rooms.

Observe the interaction between the first responders and the Ambulance personnel.

Discuss patient signs & symptoms and diagnosis with the Paramedics.

Emergency Room

Perform patient assessment including developing relevant medical history and conducting a physical

examination. The assessment, at a minimum, should include taking and recording vital signs, and auscultation of

lung sounds.

1. Assist in and review the treatment of patients, to include:

2. Monitoring vital signs

3. Bleeding control

4. Splinting

5. Patient movement

6. CPR

Observe the Emergency Room Physician during management of various cases.

Observe the Triage Nurse during various patient interactions.

Observe the interaction between the Nursing staff and pre-hospital providers.

Clinical Observation Forms The student must complete a clinical observation form for every clinical experience. The form should be filled out and

signed by the preceptor. Forms not signed by the preceptor will not be acceptable. If a student is caught falsifying clinical

documentation they will be immediately dismissed.

9

Clinical Uniform and Appearance Standards

EMT-Basic students at the Academy wear a clinical uniform to all clinicals and to some of the classroom sessions. The Academy has earned a reputation for providing well-prepared and professional prehospital care providers. To maintain this reputation, the students must present themselves in a highly professional manner while in the public’s eye and wearing the clinical uniform.

1. Dark Blue Working Pants: These can be any brand. The student should consider purchasing the pants from a company that sells uniforms to EMS workers. These pants should be well fitted to the student. No holes or frayed edges. Nye Uniform has a very good pant with cargo pockets that most the students will buy. Students are not to wear blue jeans with the uniform shirt.

2. Navy Blue Uniform Shirt: The blue uniform shirt can be long or short sleeved. The shirt will be purchased at Nye Uniform across the street from the Great Lakes EMS Academy. This shirt should be clean, well-fitted to the student, and free of wrinkles when worn in public. Student are not to wear long sleeve shirts underneath their short-sleeve uniform shirt.

3. Black Boots: Students are encouraged to purchase and wear black working boots for use in the ALS ambulance clinicals. These boots are the standard footwear for people working in EMS. Students can wear a black shoe. If back shoes are worn the student will wear dark socks. The shoe will be all black. If the shoe or boot has laces, the laces will be black. Most running shoes and tennis shoes are not appropriate.

4. Uniform Belt. The uniform will be worn with a belt. The belt will be black or dark blue. Students should use a belt that is typically used in EMS.

5. T-Shirt: Students should wear a T-shirt with the uniform. This t-shirt will be white or dark blue and will be free of any writing or graphics that can be seen through the uniform shirt.

6. Long sleeve under shirts: If a student is wearing a short sleeve uniform shirt they are not allowed to wear a long sleeve undershirt. The T-shirt should not extend farther than the uniform sleeves.

7. Name Tags and assorted Uniform Items: The student may elect to adorn their shirt with various accoutrements. Brass nameplates are common items worn on the uniform. These can be purchased at Nye Uniform for approximately $10.00.

8. Clinical uniforms are not to be worn when going to a bar. The student can just take the uniform shirt off to go into an establishment that serves alcohol. You need to pay attention to what you are doing while in uniform. You are representing our industry.

Appearance

1. Students should understand that when they are wearing the uniform they represent the Academy and the EMS industry. Students need to keep their uniforms clean, wrinkle-free, and professional looking. When wearing the Great Lakes EMS Academy uniform students should adhere to the clinical attire standards

2. Haircuts/Hairstyles: Student’s hair must be neat, clean, and secured away from the face. Male student’s hair will be no longer than shoulder length.

3. Hygiene: Students will practice good personal hygiene habits throughout the course. Students cannot smell bad while in the clinical environment. Use soap and shampoo and deodorant.

4. Facial Hair: Mustaches will be neat, clean, and kept off the upper lip. No other facial hair will be authorized. No beards, no goatees, no long sideburns. If students have facial hair while wearing an Academy uniform, they will be sent home from class or clinical.

5. Finger nails: Nails will be short and clean. Clear nail polish is preferred. No brightly colored nail polish. Acrylic nails are prohibited.

6. Jewelry: Only two stud type earrings (one in each earlobe) are allowed during clinicals. If you are going to wear an earring you need to wear two earrings. No other visual piercing will be authorized. Nothing will be worn on the eyebrows, tongue, lip, cheek, nose, or around the exterior aspect of the ear.

7. Tattoos: All tattoos will need to be covered while wearing a clinical uniform. This usually means wearing a long sleeve shirt to cover tattoos on the forearms. Visible tattoos on the neck will need to be covered.

10

Clinical Documentation Clinical experience must be documented by EMT students. We use a redundant system for this documentation.

Students must bring their clinical manual to the clinical site. When they arrive at the clinical site they should have their

clinical documentation form partially completed. This would include the demographic information and the objectives

that the EMT student would like to get accomplished during the clinical. At the end of the clinical the student must

have the preceptor complete the form and sign the form in the appropriate box at the bottom of the page.

To be completed by the student before arriving at clinical site

Student Name Clinical Site Date # hours today

Objectives 1. _______________________________________________________

2. _______________________________________________________

3. _______________________________________________________

4. _______________________________________________________

The boxes above should be completed before you get to the clinical site

Emergency Room

When the EMT student arrives at the clinical site they should introduce themselves as an EMT student at Great Lakes

EMS Academy. The student will be paired with an RN will fill the role as their preceptor. It is imperative that you

make a good first impression. You need to ensure that the preceptor understands that you are there to learn and you

would like to help in any way possible. You will find that if you pitch in and help with stuff like getting blankets and

moving patients that the Nurse will be much more likely to keep you involved.

The documentation for ER clinicals is simple. You only need to complete the Clinical Documentation Form (Page 13).

You should also track what skills you are completing so you can document those on FISDAP. You should also take a

picture (scan) the Clinical Documentation Form to upload to FISDAP.

When you are done with the clinical, make sure that you have your signature and thank the staff at the emergency room

for the experience. You should make sure to document your clinical on FISDAP within 48 hours

Ambulance

When the EMT student arrives at the clinical site they will most likely be met by a dispatcher or supervisor. You should

introduce yourself as an EMT student at Great Lakes EMS Academy. The student will be paired with an ambulance

crew. One of the crew (most likely the senior) will fill the role as their preceptor. It is imperative that you make a good

first impression. You need to ensure that the preceptor understands that you are there to learn and you would like to

help in any way possible.

The documentation clinicals is more in depth. You not only need to complete the Clinical Documentation Form (Page

15), you also need to complete 5 Patient Care Reports (PCRs). You will see that after each of the Clinical

Documentation Forms there are 5 PCRs. These forms will help you track what skills you are completing so you can

document those on FISDAP. You should also take a picture (scan) the Clinical Documentation Form and PCRs to

upload to FISDAP.

11

You will note that when you will be documenting the patient interactions under the heading; “Remarkable patient

encounters (completed by student)” on the Clinical Documentation Form. The far-left column is labeled: “PCR #. This

PCR number is a number that is generated by the student. On the first PCR, the student will create the first number and

the following numbers will run in sequence. The first number will be the year the student started EMT class. The next

number will be the month. This will be followed by the student’s initials and finally the patient count.

So, if Mike F. Johnson started class in February of 2016 the number would look like this: 201602MFJ-01

This number will be written in two places; 1) in the box below in the PCR # column and 2) in the upper right hand

corner of the PCR.

Remarkable patient encounters (completed by student)

PCR # Complaint Priority Description of patient contact (assessment, treatment and disposition)

1.

2.

Patient Care Report (PCR) 1- Form # ____________

Medical History:

When you are done with the clinical, make sure that you have the preceptor’s signature and thank the crew. It is a good

idea to offer any assistance with completing the end of shift tasks. You will need to document all your patient

interactions on FISDAP with in 48 hours.

12

Clinical Obligation Assurance

I ________________________________, understand that I am required to complete a minimal number of

hours in the clinical environment as part of my EMS training at Great Lakes EMS Academy.

_________

Initials

Clinical experience is an integral factor in Paramedic training. Failure to complete the clinical

obligation will mean the failure of the course.

_________

Initials

I understand that the hours listed below are the minimal requirements for the EMT Course at

Great Lakes EMS Academy. Students are encouraged to participate in more clinical hours.

_________

Initials

I must have all my clinical documentation complete and turned in to the Academy prior to the

end of course date. This will include the signed Clinical Documentation Forms and all the

patient experiences will be completed on FISDAP.

_________

Initials

While attending clinicals I am required to complete EMS Run Reports (Patient Care

Documentation) for patient for every patient experience. These forms will be completed while

on ALS clinicals. After the clinical, the document will be scanned and uploaded unto the

student’s FISDAP account (website).

_________

Initials

In understand the rules in the clinical environment (page 6). These rules will help provide for

my safety, as well as, the safety of the preceptors and patients. Failure to comply with these

rules may mean immediate dismissal from the Great Lakes EMS Academy.

_________

Initials

I have read and understand the Clinical Uniform and Appearance Guidelines (page 9) and I

will follow these guidelines while in the clinical environment and whenever I am wearing the

Great Lakes EMS Academy uniform.

_________

Initials

I understand the nature of pre-hospital emergency medicine and emergency departments.

There is an inherent risk of injury and exposure to infectious disease while taking care of

patients in such dynamic circumstances and environments.

Course Hours

ALS Ambulance 36

Emergency Department 12

Student Name: ________________ Signature: _________________ Date: _________

13

Clinical Documentation Form for the E.R.



Objectives 1. ______________________________________________________

2. ______________________________________________________

3. ______________________________________________________

4. ______________________________________________________

Skills Accomplished

Trauma Assessment

Medical Assessment

Basic Airway

Advanced Airway

BVM Ventilation

CPR

Vitals

Wound care

Splinting

Drug admin


Chief Complaint Description of patient contact (assessment, treatment and disposition)

Preceptor evaluation (completed by Nurse, or Doctor)

1 = disagree with statement, 2 = agree with statement, 3 = student exceeds expectations …regarding EMS student Score Notes Showed up on time and seemed ready to work / learn 3 2 1 Wrote out the objectives before coming to clinical 3 2 1 Dressed and acts professionally 3 2 1 Motivated to study and/or asks questions 3 2 1 Seeks out patient contact in the emergency department 3 2 1 Remained involved during patient care interactions 3 2 1 Seems confident with skills that have been learned in class 3 2 1

Preceptor comments (completed by Nurse, or Doctor)

Student comments regarding the clinical experience and “lessons learned”

Preceptor Name

Preceptor Signature If you have a comment about the clinical program, feel free to call the Academy during normal business hours: (616) 459-1736 or email us at: [email protected].

15

Clinical Documentation Form for an ALS Clinical (Ambulance) - 1



Objectives 1. _______________________________________________________

2. _______________________________________________________

3. _______________________________________________________

4. ________________________________________________________

Skills Accomplished

Trauma Assessment

Medical Assessment

Basic Airway

Advanced Airway

BVM Ventilation

CPR

Vitals

Wound care

Splinting

Drug admin


Pt Care Doc # Chief Complaint Priority Description of patient contact (assessment, treatment and disposition)

1.

2.

3.

4.

5.

1.

2.

Preceptor evaluation (completed by Paramedic)

1 = disagree with statement, 2 = agree with statement, 3 = student exceeds expectations …regarding EMS student Score Notes Showed up on time and seemed ready to work / learn 3 2 1 Wrote out the objectives before coming to clinical 3 2 1 Dressed and acts professionally 3 2 1 Motivated to study and/or asks questions 3 2 1 Seeks out patient contact 3 2 1 Remained involved during patient care interactions 3 2 1 Seems confident with skills that have been learned in class 3 2 1

Preceptor comments (completed by the Paramedic)


Preceptor Name


17


Medical History:

Medications:

Chief Complaint: Age: Sex: Allergies:

History:

Assessment:

Time Blood Pressure Pulse

Rate Quality Respiratory

Rate Tidal Pupils SaO2 Cardiac Rhythm

Rx Treatment

Transportation (how did the patient do after treatment)

Analysis of the Patient Interaction

Skill/Experience Observed Completed Skill/Experience Observed Completed

Medical Assessment Vitals

Basic Airway Trauma Assessment

Advanced Airway Wound care

BVM Ventilation Splinting

CPR Drug admin

What went well during this EMS call?

What would have made this call run more smoothly?

What did you learn during the call?

18


Medical History:

Medications:


History:

Assessment:




Rx Treatment








CPR Drug admin




19


Medical History:

Medications:


History:

Assessment:




Rx Treatment








CPR Drug admin




20


Medical History:

Medications:


History:

Assessment:




Rx Treatment








CPR Drug admin




21

Patient Care Report (PCR) 5 - Form # ____________

Medical History:

Medications:


History:

Assessment:




Rx Treatment








CPR Drug admin




23




Objectives 1. ____________________________________________________________

2. ____________________________________________________________

3. ____________________________________________________________

4. ____________________________________________________________

Skills Accomplished

Trauma Assessment

Medical Assessment

Basic Airway

Advanced Airway

BVM Ventilation

CPR

Vitals

Wound care

Splinting

Drug administration







Preceptor Name


25


Medical History:

Medications:


History:

Assessment:




Rx Treatment








CPR Drug admin




26


Medical History:

Medications:


History:

Assessment:




Rx Treatment








CPR Drug admin




27


Medical History:

Medications:


History:

Assessment:




Rx Treatment








CPR Drug admin




28


Medical History:

Medications:


History:

Assessment:




Rx Treatment








CPR Drug admin




29


Medical History:

Medications:


History:

Assessment:




Rx Treatment








CPR Drug admin




31




Objectives 1. ____________________________________________________________

2. ____________________________________________________________

3. ____________________________________________________________

4. ____________________________________________________________

Skills Accomplished

Trauma Assessment

Medical Assessment

Basic Airway

Advanced Airway

BVM Ventilation

CPR

Vitals

Wound care

Splinting

Drug administration







Preceptor Name


33


Medical History:

Medications:


History:

Assessment:




Rx Treatment








CPR Drug admin




34


Medical History:

Medications:


History:

Assessment:




Rx Treatment








CPR Drug admin




35


Medical History:

Medications:


History:

Assessment:




Rx Treatment








CPR Drug admin




36


Medical History:

Medications:


History:

Assessment:




Rx Treatment








CPR Drug admin




37


Medical History:

Medications:


History:

Assessment:




Rx Treatment








CPR Drug admin




Clinical Manual (2017) - Great Lakes...

Documents

Transcript of Clinical Manual (2017) - Great Lakes...