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AYES: 5 — Berman, Trillin, Stein, Ottenheimer, Johnson
ABSENT: 1 - Weldenfeld
PASSED: JUTIC 19, 2017.
APPROVED: JUne 19, 2017.
APPROVED:
ALL &4
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Janet'M. j Sirabian, Village Clerk
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THIS EMERGENCY MEDICAL SERVICES (EMS) PARAMEDIC PROGRAM FIELD
TRAINING SERVICES AGREEMENT (the "Agreement") is made as of this 19 VA- - day of
--, � 4., L"m k 2017 and effective as of March 7, 2017 (the "Effective Date") by and between
the Village of Buffalo Grove ("Village"), a home rule Municipality, and NORTHWEST
COMMUNITY HOSPITAL ("NCH"), an Illinois not -for -profit corporation that operates a hospital
at 800 West Central Road, Arlington Heights, Illinois ("Hospital").
WHEREAS, NCH, as • • its mission to promote the health of the •
arranges for the provision of a variety of services including operation of the Northwest
Community EMS System (the "System");
lja�lflrsl ATURSO I Z 6—_
WHEREAS, under Illinois law, 210 ILCS 50/3.55, the Students must fulfill clinical training
and infield supervised experience requirements mandated for licensing and approval by the
System and the Illinois Department of Health;
WHEREAS, NCH and Village wish to work together to provide the Field InternshiA
••#• to •`
NOW, THEREFORE, in consideration of the mutual promises, covenants and
agreements hereinafter described, NCH and Village agree as follows:
1.1 NCH will provide its paramedic training and education services (the "Training
Services") to the Students in a manner that meets or exceeds the National EMS
Standards. NCH represents that the Training Services provided through NCH's
Training Program meets all requirements of the Committee on Accreditation of
Educational Programs for the Emergency Medical Services Professions
(CoAEMSP) and is approved by the Illinois Department of Public Health.
1.2 NCH shall only permit Students to participate in the Field Internship who meet
Field Internship program criteria and have completed the requisite course work
and/or training as described in Exhibit Q, Paramedic StudentlProvider Agency
Memo of Understanding.
1.3 The parties acknowledge that a stipend of $1,500 (One thousand five hundred
dollars) ("Stipend") shall be assessed to the Student and collected by Harper
College to compensate the Village for providing preceptor oversight during the
Field Internship. Upon request of Village, NCH will distribute the Stipend to
Village by: (1) issuing a check directly to the preceptor identified more fully in
Section 2.1 of this Agreement; (2) issuing a check to Village; or (3) holding the
funds in escrow for Village to offset future EMS System billing (for example, In -
station costs, Image Trend fees).
1.4 NCH shall designate an employee of NCH as the Program Director of thl;
Training Program.
OE. 1 Village shall permit Students, the number of which shall be mutually agreed
upon between NCH and Village, the opportunity to participate in the Field
Internship provided by NCH working together with the Village's Fire Department.
Specifically, Students will be permitted to observe and participate in certain EMS
operations and functions under the supervision of a preceptor, as described
more fully in and in accordance with Northwest Community EMS Preceptor
Agreement attached as Exhibit C. Under the supervision of a preceptor,
Students will be permitted to ride in a Village ambulance and learn critical
paramedic skills, in accordance with the Field Internship Services listed in
Exhibit A. Village agrees to provide a minimum of three hundred (300) hours
and/or 3.5 months of Field Internship supervision during the time of each
Student's Field Internship.
2.2 In the event Village elects for any one or more of its Village employees to
participate as Students in the Training Program, Village agrees that all such
employees shall meet the Student criteria for participation in the Training
Program and comply with all applicable policies and procedures, attached as
Group Exhibit D.
2.3 Village shall designate an employee of Village as its coordinator for the
Training Program and as such, to represent Village to the NCH in the day-to-day
activities and contacts regarding the Training Program, the Training Services and
the Field Internships.
3.1. The term of this Agreement shall begin on the Effective Date stated hereinabove
and shall expire one (1) calendar year thereafter. Notwithstanding the foregoing
or any other provision of this Agreement to the contrary, either party may
terminate this Agreement for any reason, with or without cause, by giving thirty
(30) calendar days written notice to the other party.
V1
Both parties, their elected officials, officers, employees, subcontractor
representatives and/or agents, including the Students, shall treat and maintain
confidential information, any information regarding the other party's program
processes, costs, equipment, operations or customers which may be disclosed to
come within the knowledge of the parties, their elected officials, officers, employee
subcontractors, representatives and/or agents, including the Students, in t
performance of this Agreement, and shall not use or disclose its confidenti
information to the other party except as is necessary to perform the Training Progra
the Training Services and Field Internships. For purposes of this Section IV, t
Students are the agents of NCH. I
The provisions of this Section IV shall not apply to any information referred to in this
Section which either party establishes (1) has been published and has become part of
the public domain other than by acts or omissions of the other party, its employees,
representatives or agents; (2) has been furnished or made known to the other party by
third parties as matter of legal right and without restriction on disclosure or use; (3) was
in the other party's possession prior to disclosure by such parties and was not acquired
by the other party, its employees and agents directly or indirectly from the other party; or
(4) is required to be disclosed under the Freedom of Information Act (5 ILCS 140/1 et
seq.) or other law, rule or order mandating disclosure.
Except as otherwise permitted •' the Health Insurance Portability and Accountability Act
of 1996 ("HIPAX) and the rules promulgated thereunder, neither party nor any of its
employees, representatives, or agents, including the Students, may use or disclose any
individually identifiable health information ("PHI") acquired in the performance of this
Agreement, including the Training Program, the Training Services and the Field
Internships. "Individually identifiable health information" means "information, including
demographic data that relates to an individual's past, present • future • • mental
health condition, the provision of health care to the individual, where that information
identifies the individual being treated or for which there is a reasonable basis to believe it
can be used to identify the individual," for example, name, address, date of birth and
• security number. http://www.hhs.gov/oc privacy/index-htmi
k, RI
Except as otherwise specifically provided in this Agreement, any notice required or
permitted to be given under this Agreement shall be in writing and (1) delivered in
person, which delivery the recipient agrees to acknowledge in writing; (2) deposited with
the United States Postal Service, having first-class, registered or certified mail return
receipt requested postage fee prepaid, or (3) sent via a nationally recognized overnight
courier service. Such notice must be addressed as follows, or to such other address or
individual as either party may specify from time to time by written notice given by such
party.
If to Village, it shall be addressed to:
Fldtention: Chief Michael Baker
Address: 1051 Highland Grove Drive; Buffalo Grove, IL 60089-7021
Telephone Number: 847-537-0995
Email: www.wbakervbQ.ora
93
Copy to:
Village Attorney
Attention: William Raysa
Address: 233 S. Wacker Drive, Chicago, IL 60606
Telephone Number: 312-627-4025
Email: wraysa tresslerllp.com
If to INCH, it shall be addressed to.
Northwest Community Healthcare
Attn: Connie J. Mattera, MS, RN, EMT-P, TNS
EMS Administrative Director and Paramedic Program Director
901 W. Kirchoff
Arlington Heights, IL 60005
Phone: 847-618-4485
Fax: 847-618-4489
Pager: 708-999-0141
cmatterannch-org
• to:
General Counsel
800 W. Central Road
Arlington Heights, IL 60005
Reither party may assign, subcontract, delegate or otherwise transfer this Agreement or
any obligations or responsibilities hereunder without the other party's prior written
consent. This Agreement is not intended to confer upon any person other than the
parties to this Agreement any rights or remedies hereunder.
V11. ENTIRE AGREEMENT
This Agreement and each of its Exhibits incorporated as though fully set forth herein sets
forth the entire agreement between Village and NCH with respect to the subject matter
hereof. All prior negotiations and dealings regarding this Agreement and the subject
matter hereof, whether oral or written, shall be deemed superseded by and merged into
this Agreement.
The 11CA shall procure and maintain for the duration of the Agreement insurance againsy
claims for injuries to persons or damages to property that may arise from or in
connection with the performance of the Training Program, the Training Services and/or
the Field Internships by the NCH, its agents, representatives, employees or
subcontractors, including Students and preceptors.
I III I III I I I III I I I III III I I . I fiIIIIIIII 111111111151151IF1111 1111111!1I III VT0•�40
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(1) Commercial General Liability - Occurrence form;
(2) Automobile Liability;
(3) Professional Liability/ Errors and Omissions policy; and
(4) Worker's Compensation as required by the Labor Code of the State of Illinois and
Employers' Liability Insurance.
��-g I I LIP 0 11 a I I I 11Z10K I ir-M Lois egag I I 1VAer-wieJorl 1 1 0 6111910r.30YAM1111 - 0
(2) Automobile Liability: $1,000,000 combined, single limit per accident for bodily
injury and property damage.
(3) Professional Liability: $3,000,000 per occurrence and in the aggregate liability
limit for errors and omissions, professional/malpractice liability, including the
Students.
(4) Workers' Compensation and Employers' Liability: Workers' Compensation
statutory limits as required by the Labor Code of the State of Illinois, and
Employers' Liability limits of $1,000,000 per accident.
8.3 Deductibles and Self -insured Retentions. INICH's obligation hereunder may be
satisfied through a self-insurance trust maintained by NCH or its affiliates.
8.4 Other Insurance Provisions. The policies are to contain, or be endorsed to contain,
the following provisions:
2. Village, its officials, employees and volunteers are to be Co -M
named insureds with respect to liability arising out of preceptor=ce
the Training Program, the Training Services ' or the Field Internshi
performed by or on behalf of the NCH, including its Students a
preceptors, as well as equipment procured, owned, leased, hired
borrowed by the NCH in the Training Program. The coverage sh
contain no special limits on the scope of the protection afforded
Village, its elected officials, officers, employees, subcontractor.
representatives and/or agents. I
b. The NCH's insurance coverage shall be primary insurance as respec1`3
Village, its elected officials, officers, employees, subcontractor
representatives and/or agents. Any insurance or self-insuran
maintained by Village, its elected officials, officers, employee
subcontractors, representatives and/or agents shall be in excess of t
NCH's insurance and shall not contribute with it.
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C. Any failure to comply with reporting provisions of the policies shall nol
affect coverage provided to Village, its elected officials, officers,
employees, subcontractors, representatives and/or agents.
d. Coverage shall expressly state that the NCH's insurance shall apply
separately to each insured against whom claim is made or suit is brought,
except with respect to the limits of the insurer's liability.
The NCH insurer shall agree to waive all rights of subrogation against Village, its elected
officials, officers, employees, subcontractors and/or agents for losses arising from the
Training Program, the Training Services or Field Internships performed by the NCH for
Village.
Each insurance policy required by this clause shall be endorsed to state that the
coverage shall not be suspended, voided, canceled, reduced in coverage or in limits
except after thirty (30) days' prior written notice by certified mail, return receipt
requested, has been given to Village.
Certificate of Insurance:
NCH shall furnish Village with Certificates of Insurance naming Village, its officials,
agents, employees and volunteers as additional insureds, and with original
endorsements affecting coverage required by this clause. The certificates and
endorsements for each insurance policy, including the Certificates of Insurance
evidencing coverage in favor of each Student, are to be signed by a person authorized
by that insurer to bind coverage on its behalf. THE CERTIFICATES AND
ENDORSEMENTS, INCLUDING THOSE EVIDENCING THE STUDENTS' INSURANCE
COVERAGE, MUST BE RECEIVED AND APPROVED BY VILLAGE BEFORE ANY
STUDENT BEGINS ANY TRAINING SERVICES OR FIELD INTERNSHIP. These
Certificates and endorsements may be on forms provided by the Village. Village
reserves the right to request full, certified copies of the insurance policies.
In the event of the expiration of the policy period for any one or more of the NCH
insurance policies on which the Village, its officials, agents, employees and volunteers
has been named pursuant to this Agreement, NCH shall promptly furnish Village with
current Certificates of Insurance evidencing the continued coverage of the Village, its
officials, agents, employees and volunteers as required by this Agreement.
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9.1.1 Not delinquent in the payment of taxes to the Illinois Department of
Revenue in accordance with 65 ILCS 5/11-42.1-1;
0
9.1.2 Not barred from contracting as a result of a violation of either Section 33E-
3 (bid -rigging) or 33E-4 (bid -totaling) • the Criminal Code • *• (720 ILCS
5/33E-3 • 5/33E-4); and
9.1.3 Not in default, as defined in 5 ILCS 385/2, on an educational loan, as
defined in 5 ILCS 385/1.
X. EQUAL EMPLOYMENT OPPORTUNITY During the performance of this Agreement,
the NCH shall.
10.6 Permit access to all relevant books, records, accounts and work sites by personnel
of the Village and the Illinois Department of Human Rights for purposes of investigation
• ascertain compliance with the Illinois Human Rights Act • the Department's Rules
and Regulations.
6
10.7 Include verbatim • • reference provisions • this clause in every subcontract it
awards under which any portion of the contract obligations are undertaken or assumed
• that such • provisions • this contract will •` binding •r such subcontractor. In
the same manner as with other provisions of this contract, the NCH will be liable for
compliance with applicable provisions of this clause by such subcontractor; and further
it will promptly notify Village and the Illinois Department of Human Rights in the event
any subcontractor fails or refuses to comply therewith. In addition, the NCH will not
utilize any subcontractor declared by the Illinois Human Rights Commission to •
ineligible for contracts or subcontracts with the State of Illinois or any of its political
subdivisions • municipal corporations.
The NCH shall not maintain or provide for its employees any segregated facilities at any of its
establishments, and not permit its employees to perform their services at any location, under its
control, where segregated facilities are maintained. As used in this subparagraph, the term
"segregated facilities" means any waiting rooms, work areas, restrooms and washrooms,
cafeterias and other eating areas, time clocks, locker rooms and other storage or dressing
areas, parking lots, drinking fountains, recreation or entertainment areas, transportation, and
housing facilities provided for employees which are segregated by explicit directive or are in fact
segregated on the basis of race, creed, color, or national origin, because of habit, local custom,
• otherwise.
KI I 1�1 *A 11-11 Ww"I 14-1111111100111
The NCH has and will have in place and will enforce a written sexual harassment policy in
compliance with 775 ILCS 5/2-105(A)(4).
The NCH shall defend, indemnify and hold harmless Village, its elected officials, officers,
employees, subcontractors, representatives and/or .•- .•. all injuries, •.' loss,
damages, claims, suits, liabilities, judgments, costs and expenses whatsoever which may in any
way accrue against Village, its elected officials, officers, employees, subcontractors,
representatives and/or agents, arising in whole or in part in consequence of the negligent or
willful misconduct by the NCH, its employees and its agents, including the Students and the
preceptors, in performance of the Training Program, the Training Services or the Field
Internships or which may in any way result therefrom, except for that arising out of the sole
negligence or willful act of Village, its elected officials, officers, employees other than those
acting as preceptors, subcontractors, representatives and/or agents.
WAY &M
The RCM shall at all times observe and comply with all federal and state laws, local law
ordinances, and regulations which in any manner may affect the performance • th
Agreement including, but not limited to, all such enactments as exist at the present and tho
which may be enacted later by legislative bodies or tribunals having legal jurisdiction or whi
may have effect over the performance • this • The NCH shall indemnify and sa
harmless Village and all of its elected officials, officers, employees, subcontractor
representatives and agents against any claim or liability arising from or based on the violati
of such law, ordinance, regulation, order or enactment, whether by the NCH or anyone subje
to the control of the NCH. I
XVI. SEVERABILITY
If any term, covenant, or condition of this Agreement or the application thereof to any person or
circumstance shall, to any extent, be declared by a court of competent jurisdiction to be invalid,
void or unenforceable, the remainder of this Agreement or such other documents, or the
2pplications of such term, covenant or condition, to persons or circumstances other than those
?,s to which it held invalid or unenforceable shall not be affected thereby; and each term,
covenant or condition of this Agreement or such other document shall be valid and shall be
enforced to the fullest extent permitted by law.
is greemen operaM
as a waiver or estoppel thereof or with respect to any subsequent violation or breach of any of
the provisions hereof, and no waiver or modification hereof shall be effective, unless in writing
• signed by the Village.
This Agreement shall be construed under and governed by the laws of the State of Illinois, and
all • brought to enforce any item •I this Agreement shall be so brought in the Circuit Cour)
• •• • Illinois.
Each party represents and warrants that the person whose name appears on the signature
page below has or has been delegated the lawful and corporate authority to enter into this
Agreement on behalf of that party.
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WILLIAM RAINEY HARPER COLLEGE
HEALTH CAREERS DIVISION
NORTHWEST COMMUNITY HEALTHCARE PARAMEDIC PROGRAM
COURSE SYLLABUS
EMS 215 PARAMEDIC: FIELD INTERNSHIP (0/20) 4
Course Course Course Title (Lec-Lab) Credit
Prefix Number Connie J. Mattera, M.S., R.N., EMT-P Hours
Program Director
Northwest Community Hospital
901 Kirchoff Center; EMS Office
Arlington Heights, IL 60005
Office hours: M-F 0900-1700
Phone: 847.618.4480 Pager: 708.999.0141
cmaftera@nch.org
Dates: March 3, 2017 until objectives are achieved; no later than June 14, 2017 unless an extension is granted
Time & location of classes: EMS agencies within the Northwest Community EMS System
Class days: Dates and times variable depending on preceptor schedules and agency policies
COIRSE DESCRIPTION E
This course integrates the theoretical concepts and practical skills acquired during EMS 210, 211, 212, 213 and 214
and requires students to use higher order thinking and critical reasoning to safely care for patients in the out of
hospital environment under the direct supervision of an approved paramedic preceptor. The internship is divided
into two phases of ascending mastery and accountability with each having a minimum number of patient care
contacts and competencies. A full description of the objectives and expectations is contained in the NCH Paramedic
Student Handbook and on the internship forms. (NOTE: This course has an additional fee of $1500 to cover the cost
of supervision.)
Prerequisites: EMS 213 with a grade of C or better; EMS 214 with grade of P; and an approved preceptor in the NWC EMSS
Co -requisite: EMS 216
TOPICAL OUTLINE
1� I . . . . . . . . . . . . . . . ........ ......
1. Orientation to the internship
11. Phase 1: Field Experience (team member)
Ill. Phase 2: Field Internship (capstone leadership role)
IV. Mandatory actual and/or simulated skills/patient care contact��
1111ETMODS OF PRESENTATION
• Progression of learning typically sequences from didactic/theory to laboratory practice followed by clinii
experience, followed by the field internship.
• While in the field, students are awarded temporary ALS privileges and will perform to that scope of practice as
team member and then leader under the direct supervision of an approved preceptor for a minimum of 3
5
hours.
• Each phase of the internship has specific objectives, expected outcomes, and forms on which to evaluate t
learning experience. A complete description of the Internship is found in the NCH Paramedic Student Handbook.
• Students use independent inquiry to research pathophysiology and drug profiles for patient contacts.
Learning Goal: Demonstrate comReteni�%k
(behavior) learning domains.
STIDERT OITCOMES: (The student
1 during EMS 214 and 215 combined, complete the following minimum patient care contacts and demonstrate
skill competency at the precision level or higher for assessments and interventions included in the National
EMS Scope of Practice model, National EMS Education Standards, those adopted by IDPH, approved by
the EMS MID, and as specified in the System Procedure Manual:
Assessments Minimum number
Adult (18-64 yrs) ............... - ........... ............................... 50
Geriatric (65 or older) ........ ....... .................................. 30
Newborn................................ ....... -------- - - 2
Toddler.............................. ....................... .... —........ -
2
Pneochooler--------------------'
2
Sohooage........................................................
2
AdoleeconL----------------------2
Pediatric total ......................... .................. ...................
30
Trauma patients (5multi-aya0em).................. .......... ........
40
complaints ................... ........ ............ _
30
Respiratory -related complaints (aduK)----------.
10
Respiratory -related complaints (peds)--------
8
AbdomimalG|rekatedommplaints--------- ---
20
Altered mental -------------'
20
Behavioral probhyms0nboxicuhad/OD/Peyoh --.-----
20
OB(observe e1least 1vaginal delivery) ................. ----
10
across all age levels, with a 90% success rate using ET
intubation models in their last 10 attempts. Must be 100%
successful in the management of their last 20 attempts at
Serve effectively as the team leader 15 runs (10 ALS)
METHODS OF EVALUATION
1 Formative evaluations are conducted by the Field Preceptor using forms prepared by the Program to rate
student achievement of cognitive, psychomotor and affective objectives after each call. These are
discussed with the student, Field Preceptor and hospital EMS Coordinator/educator (EMSC) during Phase I
and 11 meetings
2. The program uses a computer based tracking system (FISDAP) that incorporates the program -defined
minimum numbers of encounters/competencies required for each of the defined exposure groups and
patient ages (pediatric subgroups include newborn, infant, toddler, preschooler, school-ager, and
adolescent), pathologies, complaints, and interventions. The tracking system clearly identifies those
students not meeting the program minimum numbers.
3. The program evaluates at least annually that the established minimums are adequate to achieve
competency. Terminal competency is validated by the EMS Medical Director's signature.
4. Student evaluations of preceptors and internship process
5. Employer evaluations of student readiness to work completed six months after graduation
COMPLETION OPTIONS: To successfully pass EMS 215, students must demonstrate entry-level mastery of EMS
knowledge, skills, and behaviors as measured by satisfactorily completed all objectives in the Field Internship
instruction plan. A summative evaluation is conducted with the student, their primary Field Preceptor, PEMSC and
hospital EMSC/educator when all objectives have been achieved. They may select from three options at the end of
the first 300 field internship hours:
1 . Objectives fully achieved: Graduate; recommend for terminal certifying exam and licensure without restriction.
2. Objectives minimally achieved: Graduate; recommend for terminal certifying exam; and licensure with restricti
in the form of a probationary status where the new licensee shall continue providing ALS care under the dire
supervision of an approved preceptor with periodic meetings with the EMSC/educator for an agreed -upon period
time. If this option is selected, the hospital EMSC/educator must specify in detail the rationale and objectives for t
probationary status in an education action plan (EAP) and the EMS agency chief/administrator and EMS Medic
Director must agree to the plan. A copy shall be forwarded to the Course Coordinator for the student's file.
3. Objectives not achieved: The student is given an incomplete at the end of the regularly scheduled Fie
Internship. If this option is selected, the hospital EMSC/educator must specify the cause in detail and an EAP mu
be established between the student, the primary preceptor, the PEMSC and the hospital EMSC/Educator. A co
shall be forwarded to the Course Coordinator for the student's file. The student may continue in EMS 215 with
incomplete for a maximum of one month after the class graduation date unless alternative provisions are made.
17M 017 RI Mg 11111: 4 A
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17 based on limited patient contact opportunities and slow but steady student progress. It will not be extended due to
irresponsible student behavior or persistent inability of the student to meet minimum practice standards after
reasonable remediation. Specific internship attendance requirements and consequences of failing to meet those
requirements are specified in the NCH Paramedic Student Handbook.
Information relative to civil, courteous and professional behaviors including, but not limited to, integrity, honesty,
empathy, self -motivation, appearance and personal hygiene, self-confidence, communication, time management,
teamwork, diplomacy, attitude, respect, patient advocacy, and use of electronic and social media, is specified in the
NCH Paramedic Student Handbook at www.nwcemss.org and Harper College Student Handbook at
htti)sVJmyliafi)er.t)arf)ereallectP-.edLi/pls/pc)rt�il/url/ITEM/937272F78B81316DE0402EOAOA2A3059.
Information relative to guided study, corrective coaching, disciplinary procedures, and student resources is also
included in the NCH Paramedic Student Handbook.
INSTRUCTIONAL MATERIALS: Northwest Community EMS System Standards of Practice: Standard Operating
Procedures (SOPs), Policy Manual, Procedure Manual, and Drug and Supply List.
EQUAL OPPORTUNITY
The Paramedic Program does not discriminate on the basis of race, color, religion, sex, national origin, ancestry,
age, marital status, sexual orientation, disability, or unfavorable discharge from military service as long as tht
candidate meets statutory requirements of licensure as a paramedic and is able to perform all the essential
functions of the paramedic profession during the course with or without reasonable accommodation.
STIVIDERTS111TH DISABILITIES and Academic Accommodations
If you have a disability (learning, ADHD, physical, psychological or other) and may require any accommodati
during this course, please contact the Course Coordinator at the beginning of the course to discuss. Students wi.
disabilities must contact Access and Disability Services (ADS) to discuss approval of reasonable accommodation
Any student already connected with ADS should provide the Course Coordinator a copy of your approv
Accommodation Plan if you would like to use any accommodations during the course. Access and Disabi I 1i
Services is located in Building D, D119; on the Harper College campus; 847.925.6266 (voice) or 224.836.50
(videophone for deaf and hard of hearing callers only).
STUDENT E-MAIL NOTIFICATIONS
All notifications related to student registration or other Harper College business activities are sent to students via G-
mail account that is assigned to students upon registration. Students access the G-mail account via an icon in the
student portal (where you registered for classes). Please check this e-mail frequently. To forward e-mails from this
account to a personal e-mail account please follow the instructions for forwarding Harper e-mail available to
htt2�//harpei,.blackboard.com/ . Students must provide the NWC EMSS office with an e-mail address to be used for
all direct correspondence relative to class academic and clinical activities.
5RUMFER
EXHIBIT B
Northwest Community Healthcare (NCH)
'�,aramedic Student/Provider Agency Memo of UnderstandimS
MNowrmwm�
EMER'ENCY
1
S ICES
The NCH Paramedic Program student agrees to abide by the following requirements while
riding with the hosting provider agency during EMS 215 (Field Internship):
Adhere to provider agency rules and regulations regarding appearance, dress, hair style,
body art and jewelry requirements/restrictions.
Comply with provider agency criminal background check requirements.
Comply with provider agency behavior/conduct rules and regulations.
Comply with provider agency student performance expectations throughout each phase
of the internship. The student shall not drive nor operate an agency vehicle unless an
employee of the agency.
Comply with provider agency procedures and policy related to preceptor assignment and
intern sponsorship acceptance/denial criteria.
Comply with provider agency restrictions regarding ride time/visitor hours. Note:
provider agency may restrict hours available to student based on station visitor policy,
preceptor availability, special details, holidays, etc. The student intern may be restrictet
to riding between normal working hours or specific time slots.
11 ii 0 , I -
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Student initials indicate that requirements have been explained by the Provider Agency and
understood by the student.
Student signature:
smm�
"M
MO
Initials Statements of affirmation
EXHIBIT D Northwest Community Healthcare (NCH) PARAMEDIC PROGRAM
Student Agreement 2016-2017