Medical Assisting Program...2016 through the first Friday in June 2016. Twenty (20) students will be...

Medical Assisting Program

Application

2016-17 Academic Year

MOHAVE COMMUNITY COLLEGE * 1977 ACOMA BLVD. W. * LAKE HAVASU CITY, AZ 86404 * PROGRAM SUPPORT 928-302-5373 MCC Form EDU 0042 (Revised 08/22/2015) of 24

Mohave Community College Medical Assistant Program

TABLE OF CONTENTS

EQUAL OPPORTUNITY POLICY STATEMENT .......................................................................................................................... 2

FREQUENTLY ASKED QUESTIONS: ......................................................................................................................................... 4

CLINICAL NEEDS CHECK LIST ................................................................................................................................................. 7

ADMISSION REQUIREMENTS ................................................................................................................................................. 8

APPLICATION ........................................................................................................................................................................ 9

ESSAY FORM: ...................................................................................................................................................................... 12

ADMISSION APPLICATION DISCLAIMER ............................................................................................................................... 14

DRUG SCREENING ............................................................................................................................................................... 15

BACKGROUND CHECKS ........................................................................................................................................................ 17

FINGERPRINT CARDS ........................................................................................................................................................... 17

ESSENTIAL FUNCTIONS ........................................................................................................................................................ 18

FINGERPRINT CARDS ........................................................................................................................................................... 92

PHYSICAL EXAMINATION FORM .......................................................................................................................................... 95

EQUAL OPPORTUNITY POLICY STATEMENT

Mohave Community College does not discriminate on the basis of sex, color, race, religious preference, age, disability, national origin, Veteran status or any other legally protected class in any of its policies, practices, and procedures, and it is an affirmative action and equal opportunity employer. For more information, call the Human Resources Office at 928.757.0835, 1971 Jagerson Ave., Kingman, AZ 86409. Grievance procedures are available at the Mohave Community College libraries in Bullhead City, Colorado City, Kingman and Lake Havasu City.



Dear Prospective Student: Thank you for your interest in the Medical Assisting Programs at Mohave Community College. Please review the application form prior to completion. Once you have made your decision to apply to the program, complete all the required steps. Due to limited amount of seats that are available in this program, and the amount of applications that we receive, the applications into the program will only be accepted during the designated application period of January 1, 2016 through the first Friday in June 2016. Twenty (20) students will be selected for admission into the (Medical Assisting) program per campus, and twelve (12) Phlebotomy students for each campus. Insurance Coding students must still fill out the application but, there is no limit of students accepted for Insurance Coding. See the Admission Criteria and rating system located in this packet for more information. Applications will be considered as students apply. Please note that the curriculum and prerequisites for the program will be revised periodically. It is the applicant’s responsibility to remain aware of changes that occur. For additional information, please access one of the resources below:

1. Website: www.mohave.edu MEA Information: http://catalog.mohave.edu/preview_program.php?catoid=20&poid=2821&returnto=3862 Phone: 1-866-664-2832

2. Lori Hogue, CMA, RMA, CPT, LME

Director of Medical Assisting and HIT programs Phone: (928)302-5340 E-mail: [email protected]

3. Melody Redman LPN Kingman, Resident Faculty Phone: 928-692-3071 E-mail: [email protected]

4. JoAnne Franz MS RN Bullhead, Resident Faculty: Phone: 928-704-4018 E-mail: [email protected]

5. Patti Fiscella: [email protected] Lake Havasu City, Program Secretary Office # 218 Phone: 928-302-5373

Best wishes in you educational and career pursuits. Sincerely, Lori Hogue, Director of Medical Assisting and HIT Programs

http://www.mohave.edu/

http://catalog.mohave.edu/preview_program.php?catoid=20&poid=2821&returnto=3862

mailto:[email protected]






Application Process: Prior to applying to the program, please complete the admissions application process. See link below:

http://www.mohave.edu/Assets/documents/Repository/EDU/edu_0042.pdf)

FREQUENTLY ASKED QUESTIONS: 1. WHAT CAN I DO TO GET READY NOW?

Review the Essential Functions of a Medical Assistant/Phlebotomist found on page 39 to make sure you can perform those selected activities.

Complete requirements to obtain your high school diploma or GED.

TEAS V exam is required and reviewed for consideration into the program.

Contact Academic Advising to determine your need for any assessment tests in English and Math (Placement test).

If needed, enroll in Transitional Math and/or English to be eligible for college level courses. NOTE: In order to apply to the MEA program, students must receive an appropriate score on the Placement exam, or successful completion of TRE 089, PCS 021, and TRM 090 (Prerequisites).

Taking any of the following general education courses prior to applying for the MEA program will increase your points toward admission.

o BIO 100 Biology Concepts (Prerequisite) o BIO 201 Human Anatomy & Physiology I o BIO 202 Human Anatomy & Physiology II o ENG 101 English Composition I o PSY 101 Introduction to Psychology o CIS 110 Introduction to Computer Information Systems *Be aware that some courses may have additional pre-requisites associated with them.

The following students must take STU 101 prior to applying to the MEA program: o Cumulative High School or College GPA of less than 2.7 (4.0 scale); and/or o If you have not taken at least 12 credits in the last 3 years.

Become certified in CPR at the Healthcare Provider level through (American Heart Association-Healthcare Provider or the American Red Cross Professional Rescuer level). Community basic or child CPR courses are NOT accepted.

2. WHAT IS THE DIFFERENCE BETWEEN A MEDICAL ASSISTANT, PHLEBOTOMIST AND INSURANCE CODING SPECIALIST?

a. Medical Assistants are an integral member of the health care delivery team. Medical Assistants performs administrative, clinical and laboratory roles. They are the liaison between the doctor and patient.

b. Phlebotomist perform venipuncture and other specimen collection in the outpatient laboratory setting or within the hospital setting.

c. Insurance Coding is performed within the ambulatory medical office, hospital, and many insurance agencies. There is no patient care involved in the billing and coding specialty.

http://www.mohave.edu/Assets/documents/Repository/EDU/edu_0042.pdf



3. WHAT EDUCATION IS NECESSARY FOR A MEDICAL ASSISTANT? a. Medical Assistants must complete a minimum of 900 clock hours (or equivalent) of training in

Medical Assisting skills (including a 180 hours of externship in a clinical setting). b. Phlebotomist must complete a minimum of 240 hours of course work and training in phlebotomy

skills including, 120 hours in a clinical laboratory setting and obtain 100 successful blood draws. c. Insurance coding students must complete the required courses set by the credentialing agency to

be eligible to sit for national certification.

4. WHAT IS THE CURRENT JOB MARKET? a. The job market for Medical Assistants is projected to continue to grow for the next several years

both locally in Arizona and throughout the country. The United States of Labor Statistics forecasts that through 2020 the demand for Medical Assistants will grow by 32%, much faster than the average for all occupations. Opportunities for individuals interested in becoming Medical Assistants are expected to be very good.

5. WHY SHOULD I CONSIDER A CAREER IN MEDICAL ASSISTING? a. A career in Medical Assisting is very rewarding. Each day Medical Assistants work closely with their

patients to help them recover from injuries or illnesses that have temporarily or permanently changed their lives. Medical Assistants are important members of the medical team. Helping people to progress back towards optimal health is a wonderful experience.

b. Medical Assistants are men and women who enjoy challenging work, communicating with people, and working in a team environment to assist patients to achieve their fullest health potential.

6. CAN I APPLY IF I HAVE A CRIMINAL RECORD? Yes, you may apply to the Medical Assistant program if you have a criminal record. You must be able

to achieve clearance through a background check upon admission. You will also be required to

obtain a fingerprint clearance card prior to clinical education experience (externship site).

a. Upon graduation from the Medical Assisting program you must apply to the credentialing agency for credentialing. The credentialing agency has the ultimate authority to grant credentials in the state of Arizona. They can make this determination after reviewing the credentialing application, including examination of criminal history.

b. Agreements with the healthcare facilities require that students receive a Fingerprint Clearance

Card issued by the Arizona department of Public Safety. Additionally, a student must not be

listed on the Federal Government’s Office of the Inspector General’s Exclusion List. Students

that are unable to obtain either of these clearances will be prohibited from attending the

Medical Assistant Program at Mohave Community College.

7. HOW MANY STUDENTS WILL BE ADMITTED TO THE PROGRAM? a. A new class of up to 20 Medical Assisting students and 12 Phlebotomy students per campus will

be admitted each August to the traditional program. The number of students admitted may change depending on employment market conditions and the availability of clinical training sites. There is a selection process and a deadline to submit applications. In the event of a tie in rank,



the space will go to the person who submits their application the earliest. There is no student limit in the Insurance Coding courses.

8. WHAT HAPPENS TO MY APPLICATION IF I AM NOT ONE OF THE FIRST 20 APPLICANTS? a. The application remains on file. If a student in the initial acceptance group is unable to take their

space, the position is offered to the next ranked applicant. For reconsideration for the following year, a new application must be submitted.

9. HOW LONG DOES IT TAKE TO COMPLETE THE PROGRAM? a. The Medical Assisting AAS program at MCC is an integrated 2 year program and can be

completed in 4 semesters including general education courses and the externship. (Fall, Spring, Fall, Spring). Part time students will take longer to complete depending on the number of classes taken each semester.

b. The Phlebotomy Certificate program at MCC is an integrated 1 year program and can be completed in 2 semesters. (Fall, Spring). Part time students will take longer to complete depending on the number of classes taken each semester.

c. Insurance Coding Certificate program at MCC is an integrated 1 year program and can be completed in 2 semesters. (Fall, spring). Part time students will take longer to complete depending on the number of classes taken each semester.

d. Each of the programs at Mohave Community College is an integrated 1 or 2 year program and

can be completed in 2-4 semesters. If all lecture, laboratory, and clinical courses are completed

satisfactorily students will be able to graduate within 1-2 years. Many students take a year prior

to actually beginning the program courses to complete program prerequisites that are required

for the Associate in Applied Science (AAS) degree.

e. Please be aware that a semester below 12 credits can affect a student’s financial aid.

MEDICAL ASSISTING AND PLHEBOTOMY STUDENTS NEED TO COMPLETE ALL CLINICAL REQUIERMENTS BELOW.

APPLICATIONS WILL NOT BE ACCEPTED WITH MISSING DOCUMENTS. ANY APPLICATION SUBMITTED WITH

MISING DOCUMENTS WILL NOT BE CONSIDERED FOR ACCEPTANCE TO THE PROGRAM.

INSURANCE CODING STUDENTS DO NOT NEED TO SUBMIT CLINICL DOCUMENTS.



CLINICAL NEEDS CHECK LIST

NOTE: Individual clinical needs documents will not be accepted until check list is complete. Please turn in a completed packet of clinical needs documents from the checklist when completed. STUDENT ID # AGE MALE FEMALE

FIRST NAME MIDDLE INITIAL LAST NAME

BACKGROUND CHECK – Pre-check form. Background check

is good for the duration of the program. Date: ___________________________________

FINGERPRINT CLEARANCE CARD – AZ Department of Public Safety. Fingerprint card is good for 6 years. Date: ___________________________________

HEALTH CARE PROVIDER CPR – Must be obtained through either the American Red Cross or the American Heart Association, classes offered through Community Outreach program at MCC. CPR is good for 2 years. Date: ___________________________________

HEALTH INSURANCE – Student’s personal health care insurance. You must provide your own health insurance. Date: ___________________________________

PHYSICAL – Student’s healthcare provider. Physical is good for the duration of the program. Date: ___________________________________

DRUG SCREENING – MEA DEPARTMENT WILL NOT PAY FOR YOUR SCREENING. Do not make an appointment for this. Drug Screen is done through PreCheck. Please log into the site and select your area of interest, Medical Assisting or Phlebotomy and follow instructions for testing. Date: ___________________________________

ANNUAL TB TEST – If you have never had a TB Test you will

need the 2-Step TB. Annual TB test is good for 1 year. If you have had a chest x-ray that is good for two years.

NOTE: A second background check and drug screen will be required before entering into the externship course.

Process for 2-Step TB – The 1st step is an injection from your health care provider followed up with a reading 2-3 days after the injection. The 2nd step repeats the process 1-3 weeks after the 1st reading. 2-step TB is not complete until the second test is read. 2-StepTB test is good for 2 years.

Date: _____________________________

HEP B OR TITER – (optional but highly recommended - if titer is low or no immunity you will need the HEP B vaccine or you must sign a declination form) Hepatitis B is contracted from blood borne pathogens.

Three immunization series – 1. 1st injection of vaccine

Date: ___________________________________

2. 2nd injection is administered 30 days after 1st injection. Date: ___________________________________

3. 3rd injection administered at the end of the 5th month. Date: ___________________________________ All 3 vaccinations must be completed in order to obtain full immunity.

VARICELLA (chicken pox) TITER – (if titer is low or no immunity you will need the Varicella vaccine and a second titer to show immunity). Date: ___________________________________

MMR (Measles, Mumps, and Rubella) TITER – (if titer is low or no immunity you will need the MMR vaccine and a second titer to show immunity. Date: _____________________________________



MCC ID__________________Name_______________________________________________Date______________

ADMISSION REQUIREMENTS USE THIS CHECKLIST TO SUBMITT A COMPLETED APPLICATION

1. MCC’s Online Admissions Application (Become a Student)

2. All Official College Transcripts (if any) – Official transcripts are sent from Institution to Institution. Transcripts mailed to the student are considered unofficial.

3. High School Transcripts OR GED scores.

4. Proof of college level reading and math skills via the Placement Test or Transcripts

5. Demonstrate an overall GPA of 2.7

6. TRM 090 or higher

7. PreCheck Criminal Background Check

8. Fingerprint Clearance Card

9. TEAS V Examination Result Packet

10. Medical Assisting Program Application

11. Admissions Application Disclaimer Signature Page

12. Criminal Background Self-Disclosure Signature Page

13. Drug Screening Disclaimer Signature Page

14. Essential Functions Signature Page

15. Background and Fingerprint Signature Page

16. Demographic Page

SELECTION CRITERIA

COURSES A B C Points

PREREQUISITES TRM 090 or higher (Letter grade not a

warded) N/A

TRE 089 or higher GENERAL EDUCATION BIO 100 3 2 1 BIO 201 3 2 1 BIO 202 3 2 1 PSY 101 3 2 1 ENG 101 3 2 1 CIS 131 3 2 1

TEAS V EXAM 5 points 50% to 10 points 61% to

60% 100%

RESIDENCY Points Points

County Resident 2 Arizona Resident 2

WORK EXPERIENCE Points Points

Medical Assisting Related: 1 year or more experience 7 Healthcare Related: hospital, skilled nursing facility, and/or front medical

office; 1 year or more experience 5

Phlebotomy or Coding and 1 year or more work experience in the field 5

ADDITIONAL COURSE COMPLETION POINTS Points Points

Completion of 5 to 6 of the above prerequisites & general education 10 Completion of 3 to 4 of the above prerequisites & general education 6 Completion of 1 to 2 of the above prerequisites & general education 2

Total Points________________



APPLICATION

If you have any physical or mental impairment contact: Disability Services: (928) 680–5946

PLEASE PRINT OR TYPE

Name: ____________________________________________________________________________________

Former name(s) which may appear on transcripts: ________________________________________________

Are you currently enrolled at MCC? YES or NO (Please Circle Yes or No)

Student ID # __________________

Home Address: _____________________________________________________________________________

City: _________________________________________________ State: _________ Zip __________________

Home Phone: ___________________________ Work/Cell Phone: ___________________________________

Email: __________________________________________________________________

WORK EXPERIENCE: (LAST 5 YEARS, BEGINNING WITH MOST RECENT)

EMPLOYER POSITION DATES PHONE REASON FOR LEAVING

From:

To:

From:

To:

From:

To:

From:

To:

From:

To:

NOTE: It is the applicant’s responsibility to assure that the information on this application remains current.

All qualified applicants are considered for admission, and students are treated without regard to race, color, religion,

sex, national origin, age, or marital status. Information related to these areas will be used for statistical analysis and

not as criteria for admission to the Medical Assisting program. All information will be kept confidential.



AREA OF INTEREST

Please select from the following location(s) you wish to be considered for:

_____ Medical Assisting AAS ____ Insurance Coding Certificate _____ Phlebotomy Certificate

_____ Kingman Campus _____ Lake Havasu City Campus _____ Bullhead City Campus

_____ Full Time Student _____ Part Time Student

APPLICANT INFORMATION

Date: ________________ Social Security # (Last four digits) ________________ MCC ID #: _________________________________

Full Name: __________________________________________________________________________________________________

Mailing Address: _____________________________________________________________________________________________

Home Phone: ______________________________________ Cell Phone: _____________________________________________

Email Address: _______________________________________________________________________________________________

ACADEMIC HISTORY

List all colleges, universities and institutions attended, including high school.

High School: _______________________________ Location: ___________________ Degree: ____________ Date: ____________

College: _______________________________ Location: __________________ Degree: ___________ Date: _____________

College: _______________________________ Location: __________________ Degree: ___________ Date: _____________

Other: _______________________________ Location: __________________ Degree: ___________ Date: _____________

Courses Completed Prior to Application:

____________________________________________________________________________________________________________

____________________________________________________________________________________________________________

____________________________________________________________________________________________________________

Gender, Birth Date, Marital Status, and Ethnicity/Race

Responses to Gender, Birth Date, Marital Status, and Ethnicity/Race are voluntary and will be kept confidential. Failure to furnish this

information will not adversely effect of this application; it is for statistical purposes only.

Gender: _____Male _____Female Birth Date: ________/________/________ Age: _____________

Marital Status: _____ Single _____Married _____Divorced _____ Widowed

Maiden Name: _________________________________________ Other Name(s) Used: ______________________________

Ethnicity/Race

_____ American Indian or Alaskan Native _____ Asian or Pacific Islander _____ Hispanic

_____ Black/Non-Hispanic _____ White/Non-Hispanic _____ Other/Unknown



Answer the Following Questions

1. Have you ever been addicted to habit-forming Drugs? YES _____ NO _____

If YES, please explain

__________________________________________________________________________________

2. Do you have any physical or mental limitations? YES _____ NO _____


___________________________________________________________________________________

3. Have you ever been convicted of a felony? YES _____ NO _____


___________________________________________________________________________________

Disclaimer and Signature

I understand that if accepted into the MA program, I may be required to travel to other communities

for my clinical externship experiences, and that I will be responsible for my own transportation and

meals.

I understand that if accepted, I will be required to meet the health requirements of the MA program.

I hereby certify that the facts set forth in this Student Application are true and complete to the best

of my knowledge. I understand that if accepted into the MA program, any falsified statements on this

application shall be considered cause for suspension or dismissal.

Signature: _________________________________________________________ Date:_________________

Mail COMPLETED Application To:

Medical Assisting Department

Attn: Lori Hogue, Program Director

1977 Acoma Blvd West

Lake Havasu City, AZ 86403



ESSAY FORM: IN YOUR OWN HANDWRITTING, ANSWER THE FOLLOWING QUESTIONS:

1. What made you decide to become a Medical Assistant/Phlebotomist?

2. How did you become interested in the profession of a Medical Assistant/Phlebotomist? Include information regarding prior work, educational, or personal experience.



3. Please share something about yourself that is not included in this application which would be of interest to

the admissions committee.



ADMISSION APPLICATION DISCLAIMER

Your admission to the Mohave Community College Medical Assisting Program does not guarantee you will receive

an Associate in Applied Science Degree from the College or a Certificate of Proficiency. Further, completion of

the Medical Assisting Program is not the sole criterion for obtaining a license/certificate to practice.

Licensing/certification requirements are the exclusive responsibility of the individual Credentialing Boards of

Medical Assisting or similar agencies, and you must satisfy those requirements independently of MCC.

CERTIFICATION

I hereby certify that the facts set forth in this student application are true and complete to the best of my

knowledge. I understand that if accepted, any falsified statements on this application shall be considered

sufficient cause for suspension or dismissal.

CLINICAL EXPERIENCE

MCC Medical Assisting students are required to provide their own transportation to the clinical site. Every attempt

is made to arrange the location of the clinical education site with respect to the geographic location of the student’s

residence. Understand, that Mohave County is considered rural. Students may be required to travel up to an hour

each way, to and from the clinical site. Unwillingness or inability to travel to a site outside of the students’ local

geographic location will delay completion of the program.

All fees associated with housing and transportation to and from the clinical site is the responsibility of the student.

I understand that if accepted, I will be required to meet the health requirements of the Medical Assisting

Program.

STUDENT’S NAME (PRINT)

STUDENT’S SIGNATURE DATE

SUBMIT TO: Mohave Community College Lori Hogue Director of Medical Assisting 1977 Acoma Blvd West Lake Havasu City AZ 86403 [email protected]

__________________________________________________




DRUG SCREENING Each student must go through a preclinical drug screen prior to beginning the clinical rotation. The urine drug screen will test for alcohol; illegal drugs, or drugs that may impair judgment while working with patients at the clinical site. If the drug test is positive for the illegal drugs, or drugs that may impair judgment or motor function the student may not be able to continue in the program. Readmission is at the discretion of the college and the program director. Some clinical sites also require screening for nicotine. Students who test positive for nicotine may not be able to be placed at some clinical sites, but are not excluded from the program.

Note 1: Please keep a copy for your records.

Note 2: Drug screening will be required of students as a condition of eligibility to participate in clinical practicum. Be advised that a positive result on a drug test will result in consequences that will vary depending on the level of severity and the need for additional treatment. At the very least the student will be unable to attend a clinical class or clinical externship until cleared to do so. Other potential consequences may include suspension or expulsion.

CRIMINAL BACKGROUND

CRIMINAL BACKGROUND SELF-DISCLOSURE Prior conviction of a felony or certain misdemeanors, other than minor traffic offenses, may make a student ineligible to participate in various clinical experiences and possibly make it impossible for a student to complete the scheduled program of study. Prior conviction of a felony or misdemeanor may make the individual ineligible for professional licensure, professional certification, or professional registration, dependent on specific regulations of individual state of practice.

PLEASE NOTE Convictions or charges resulting in any of the following must be reported: plea of guilty, plea of nolo contendere (no contest), withheld or deferred adjudication, suspended or stay of sentence, and/or military court martial.

HAVE YOU EVER BEEN CONVICTED OF A MISDEMEANOR OR A FELONY? Misdemeanor charges or convictions that occurred while a juvenile and that were processed through the juvenile court system are not required to be reported. Misdemeanor speeding convictions are not required to be reported unless they are related to alcohol or drug use.

1. Have You Ever Been Convicted of a Misdemeanor or a Felony? Circle One: Yes No

2. If response is YES, list all offenses, dates, locations of courts, and outcomes. Official court documentation may be required by the licensing agency.

My statement regarding my criminal background is accurate to the best of my knowledge. I understand the falsification or omission of information may result in disqualification or dismissal of this application for admission to Mohave Community College Medical Assisting Program.

I hereby certify that the statements on this application are correct to the best of my knowledge and I understand



that falsification or omission of information may result in disqualification or dismissal of this application for admission to Mohave Community College Medical Assisting Program.

I authorize official representatives of Mohave Community College Medical Assisting Program to verify information provided in this application. Application materials submitted as part of the application process become the property of Mohave Community College Medical Assisting Program. Materials will not be returned, and copies will not be provided. I agree to abide by the policies and regulations of Mohave Community College Medical Assisting Program.



SUBMIT TO: Mohave Community College Lori Hogue Director, Medical Assisting Programs

1977 Acoma Blvd West Lake Havasu City, AZ 86403 Phone: 928-302-5340 [email protected]


Mohave Community College * 1977 Acoma Blvd, West * Lake Havasu City, AZ 86403 * PTA Program Support 928-505-3351

Page 90 of 120 Revised 7/15/15


BACKGROUND CHECKS

I understand that a positive result on the background check could preclude me from clinical affiliations at certain facilities since each clinical site has their own criteria. I also understand that this could affect my ability to graduate from the program. In addition, I understand that a positive background check will need to be addressed with the credentialing board for Medical Assistants/Phlebotomists and that it may preclude me from obtaining a certification to practice as a Medical Assistant/Phlebotomist.



FINGERPRINT CARDS

I , understand that I must present a valid AZ DPS fingerprint card in order to participate in all clinical education experiences. I must report any incident to the program within 7 days that may affect my status. If I am on a clinical experience, I have 24 hours to report the incident to the program.

I acknowledge failure to maintain a valid Fingerprint Card may also be cause for dismissal from the program.



(PLEASE SIGN AND RETURN WITH COMPLETED APPLICATION)

Mohave Community College * 1977 Acoma Blvd, West * Lake Havasu City, AZ 86403 * PTA Program Support 928-505-3351



ESSENTIAL FUNCTIONS THE FOLLOWING IS A LIST OF PHYSICAL AND MENTAL JOB EXPECTATIONS FOR A MEDICAL ASSISTING STUDENT

A medical assistant/phlebotomy student MUST be able to perform the following functions:

1. Demonstrate visual acuity and auditory ability to assess the condition of a patient and administer effective

patient care and read doctor’s orders and medical dosages on syringes and vials.

2. Manual dexterity, eye-hand coordination, fine and gross motor skills, and tactile abilities to manipulate

syringes, vials, pills, buckle and unbuckle, apply dressings and binders, remove sutures, and perform

CLIA waived tests.

3. Demonstrate critical thinking and problem solving skills for effective patient management and

implementation of medical orders.

4. Maneuver equipment in a patient’s room and in the medical office and treatment rooms.

5. Work in stressful situations that require quick thinking and the simultaneous coordination of a variety of

activities.

6. Demonstrate physical agility to respond to patient and family needs, including unexpected changes in the

patient’s status.

7. Demonstrate the physical ability to assist patients in ambulating, positioning, and transferring from the

bed/table, wheelchair or car.

8. Perform basic resuscitation and emergency procedures according to CPR protocols

9. Assist with or administer treatments and therapies using potentially hazardous equipment (i.e. needles,

caustic drugs, X-rays).

10. Demonstrate proper body mechanics for lifting.

11. Lift objects in excess of 50 pounds without assistance.

12. Tolerate prolonged standing, stooping, squatting, bending, pushing, and pulling. 13. Stand and walk continuously for up to eight hours.

14. Safely handle blood and other body excretions and secretions 15. Perform effectively under stress.

16. Demonstrate effective verbal and non-verbal communication skills with internal and external customers.

Graduates who are unable to perform these functions, with or without reasonable accommodations, may be unsafe and unsuccessful as a provider of medical assisting services.

Mohave Community College * 1977 Acoma Blvd, West * Lake Havasu City, AZ 86403 * MEA Program Support 928-302-5373



ESSENTIAL FUNCTIONS UNDERSTANDING OF REQUIREMENTS

As a medical assisting student of MCC, I understand I must be able to meet the above physical requirements. I have read and understand the requirements, and I am able to perform all the above listed functions.

As a medical assisting student of MCC, I understand that I must provide the following requirements:

1. Proof of current vaccinations and verification of immunity through positive titer’s

2. MMR, Varicella, Hepatitis B Series, Negative TB (2-step) or Chest X-ray

3. Current CPR certification (Heart Saver, Adult or Community CPR is not acceptable)

4. Negative Drug screen (positive results must be followed up with verifiable proof of prescriptions) 5. Current Physical Examination provided by a Medical Physician (MD), Nurse Practitioner (NP), Physician

Assistant (PA) or Doctor of Osteopathy (DO). 6. Physical Examinations performed by a Chiropractor (DC) are NOT acceptable for the Medical Assisting Program.

As a Medical Assisting student of MCC, I understand that failure to provide CURRENT documentation will result in dismissal from the Medical Assisting program.






FINGERPRINT CARDS

I, ______________________________, understand that I must present a valid AZ DPS fingerprint card in order to participate in all clinical education experiences. I must report any incident to the program within 7 days that may affect my status. If I am on a clinical experience, I have 24 hours to report the incident to the program.

I acknowledge failure to maintain a valid Fingerprint Card may also be cause for dismissal from the program.

______________________________________ _________________________ SIGNATURE DATE _________________________________________ PRINTED NAME

(Please sign and return with completed application)

Fingerprint cards and applications can be picked up at any Student Service Office, from the Program Secretary, or the Program Director. You can also visit: http://www.azdps.gov/services/fingerprint/

a. In frequently asked questions: b. How can I obtain an application packet for an initial or Regular Fingerprint Clearance Card? c. Click on link for contact information

http://www.azdps.gov/services/fingerprint/

http://www.azdps.gov/services/fingerprint/#15




INSTRUCTIONS FOR OBTAINING YOUR BACKGROUND CHECK and DRUG SCREENING FOR A CLINICAL EDUCATION PROGRAM

Mohave Community College –Medical Assistant Background Check and Drug Screen

Background checks and drug screening are required on incoming students to ensure the safety of the patients treated by students in the clinical education program. You will be required to order your background check and complete the drug

screening in sufficient time for it to be reviewed by the program coordinator or associated hospital prior to starting your clinical rotation. A background check typically takes 3-5 normal business days to complete, and turnaround time of the drug screening

results is determined by a variety of factors. The background checks are conducted by PreCheck, Inc., a firm specializing in background checks for healthcare workers. The drug screening service is conducted by E-Screen/Pembrooke. All your orders

must be placed online through StudentCheck.

Go to www.mystudentcheck.com and select your School and Program from the drop down menus for School and Program. It is important that you select your school worded as

Mohave Community College –Medical Assistant Background Check and Drug Screen OR Mohave Community College Phlebotomy Background Check and Drug Screen

Complete all required fields as prompted and hit Continue to enter your payment information. The payment can be made

securely online with a credit or debit card. You can also pay by money order, but that will delay processing your background check until the money order is received by mail at the PreCheck office. Texas residents will pay $107.71 and New Mexico

residents will pay $106.71. Residents in all other states will pay $99.50. For your records, you will be provided a receipt and confirmation page of background check and drug screening through PreCheck, Inc.

Drug Screening:

You must pre-register for drug screen collections before heading to a collection lab.

If you pay by credit card, the link to the instructions for pre-registration will be provided at the confirmation page after you complete your order.

If you are paying by money order, you will be emailed instructions to obtain your drug screen once payment has been received.

Note on Drug Screen Collection Pre-Registration and Appointments: This process only pre-registers you for a drug screen and does not set up an appointment time with the collection site. Collection sites have different policies on setting up appointments for drug screening. For your convenience, we recommend calling your chosen collection site ahead of time to set up an appointment. It is also your responsibility to pre-register and complete the drug screen at the time frame required by the school. For most students, the Electronic Chain of Custody (ECOC) process will register them to a collection site instantly; however the location of some students may require us to mail a paper Chain of Custody Form to get you to a collection site close to your location. We encourage you to pre-register with enough time to allow mailing time, if needed. PreCheck will not use your information for any other purposes other than the services ordered. Your credit will not be investigated, and your name will not be given out to any businesses.

FREQUENTLY ASKED QUESTIONS:

Does PreCheck need every street address where I have lived over the past 7 years? No. Just the city and state.

I selected the wrong school, program, or need to correct some other information entered, what do I do? Please email [email protected], with the details

.

How long does the background check take to complete? Most reports are completed within 3-5 business weekdays.

How long does the drug screening take to complete? Screening can be impacted by a variety of factors.

Do I get a copy of the background report? Yes. Log into www.mystudentcheck.com and click on “Check Status”, and enter your SSN and DOB. If your report is complete, you may click on the application number to download and print




a copy. This feature is good for 90 days after submittal. After 90 days, you will be charged $14.95 for a copy of your report, and will need to contact PreCheck directly to request this.

Do I get a copy of the drug screening? Your school or clinical site may have a designated administrator who receives results via fax or through e-results, however if they direct you to contact PreCheck please email your name, request and the last 4 digits of your SSN to [email protected]. We will advise you of whether we house the results.

I have been advised that I am being denied entry into the program because of information on my report and that I should contact PreCheck. Where should I call? Call PreCheck’s Adverse Action hotline at 800-203-1654. Adverse Action is the procedure established by the Fair Credit Reporting Act that allows you to see the report and to dispute anything reported.




PHYSICAL EXAMINATION FORM “STUDENT USE ONLY”

(Student must complete this side)

Student Name:

Address:

City:

State:

Zip:

Home Phone:

Cell Phone:

Medical Assisting/Phlebotomy Student Qualifications

A Medical Assisting/Phlebotomy student MUST be able to perform the following functions: 1. Stand and walk continuously for up to eight hours. 2. Visual acuity and depth perception to read physical therapist orders. 3. Hearing acuity and to hear machine alarms, announcements on PA systems, normal conversations, and through

stethoscopes. 4. Safely handle blood and other body excretions and secretions. 5. Perform basic resuscitation and emergency procedures according to CPR protocols. 6. Lift, move, position, and otherwise handle patients to minimize discomfort and provide basic care. 7. Ability to lift 50 pounds. 8. Lift, move, and operate equipment used in the care of patients. 9. Assist with or administer treatments and therapies using potentially hazardous equipment (i.e. needles, caustic drugs, X-

rays). 10. Manual dexterity to manipulate syringes, vials, pills, buckle and unbuckle, apply dressings and binders. 11. Psychological stability to perform effectively under stress. 12. Ability to exercise critical thinking reasoning and judgment in a client care situation.

Understanding of Requirements

As a Medical Assisting/Phlebotomy student of MCC, I understand I must be able to meet the above physical requirements. I have read and understand the requirements, and I am able to perform all the above listed functions.

As a Medical Assisting/Phlebotomy student of MCC, I understand that I must provide the following requirements: 1) Proof of current vaccinations and verification of immunity through positive titer’s

a. MMR b. Varicella c. Hepatitis B Series

2) Negative TB (2-step) or Chest X-ray 3) Current CPR certification (Heartsaver, Adult or Community CPR is not acceptable) 4) Negative Drug screen (positive results must be followed up with verifiable proof of prescriptions) 5) Current Physical Examination provided by a physician found on the back of this form

As a Medical Assisting/Phlebotomy student of MCC, I understand that failure to provide CURRENT documentation will result in dismissal from the Medical Assisting/Phlebotomy program.

COMMENTS:

Student Name (please print):_______________

_______________________________Date: _____________

Student Signature:

MOHAVE COMMUNITY COLLEGE * 1977 ACOMA BLVD. W. * LAKE HAVASU CITY, AZ 86404 * PROGRAM SUPPORT 928-302-5373 MCC Form EDU 0032 (Revised 8/22/2015) Page 96 of 24

Mohave Community College Medical Assisting Program

“PHYSICIAN USE ONLY” (Physician must complete this side)

STUDENT NAME:

HEENT: Lungs: Heart: Abdomen:

Vital Signs: Extremities/Joints: Neurological/Mental:

VISION: (R) (L) CORRECTED: (R) (L)

Please list all prescription medications being used by the student and the reason:

Please list all chronic conditions or medical problems the student has:

Record of Immunizations: (PROOF is required for all Immunizations or Titers)

Clinical sites utilized for MCC Medical Assisting/Phlebotomy student Clinical Experiences require proof of all of the following Titers and tests. Students will only be allowed an exception based on a medical condition and a physician’s note is required.

MMR Proof of

Positive Titer

Date: Varicella Proof of

Positive Titer

Date: Influenza (Annual)

Date:

Titers Date: Titers Date:

Please include copies of all titers Please include copies of titers

Hepatitis B Series (or) status of

Immunity With a positive Titer

#1. Date:

TB Skin Test Negative (2-Step)

(or) Negative X-Ray

#1. Date: #2. Date: #2. Date: #3. Date: X-Ray Date:

Titers Date:

Please list mm and induration

Medical Assistant/Phlebotomy Student Qualifications

A medical assistant/phlebotomy student MUST be able to perform the following functions: 1. Stand and walk continuously for up to eight hours. 2. Visual acuity and depth perception to read doctor’s orders and medical dosages on syringes and vials. 3. Hearing acuity to hear machine alarms, announcements on PA systems, normal conversations, and through stethoscopes. 4. Safely handle blood and other body excretions and secretions. 5. Perform basic resuscitation and emergency procedures according to CPR protocols. 6. Lift, move, position, and otherwise handle patients to minimize discomfort and provide basic care. 7. Ability to lift 50 pounds without assistance. 8. Lift, move, and operate equipment used in the care of patients. 9. Assist with or administer treatments and therapies using potentially hazardous equipment (i.e. needles, caustic drugs, X-rays). 10. Manual dexterity to manipulate syringes, vials, pills, buckle and unbuckle, apply dressings and binders, remove sutures, and

perform CLIA waived tests. 11. Psychological stability to perform effectively under stress. 12. Ability to exercise critical thinking reasoning and judgment in a client care situation.

Physicians Signature of Authorization

Based on this physical examination, do you find this person capable of performing ALL of these functions without ANY reservations? YES: NO:

(If No, Please Explain):

Physician Name (please print): Date:

Physician Signature: Telephone:

Address: City: State: Zip:

Medical Assisting Program...2016 through the first Friday in June 2016. Twenty (20) students will be...

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Transcript of Medical Assisting Program...2016 through the first Friday in June 2016. Twenty (20) students will be...