medical assisting program - mohave community … assisting program clinical needs check list ......

Medical Assisting Program

Application

2017-18 Academic Year

Mohave Community College * 1977 Acoma Blvd, West * Lake Havasu City, AZ 86403 * PTA Program Support 928-505-3351 MCC Form EDU 0032 (Revised 7/01/2016) of 22

Mohave Community College Medical Assistant Program

TABLE OF CONTENTS

Equal Opportunity Policy Statement ...................................................................................................................................... 2 Anti-Discrimination Policy ...................................................................................................................................................... 2 Program Contact Information................................................................................................................................................. 3 Frequently Asked Questions: .................................................................................................................................................. 4 Medical Assisting Program Clinical Needs Check List ............................................................................................................. 7 Resource For Immunizations: ................................................................................................................................................. 8 Admission Requirements ........................................................................................................................................................ 9 Selection Criteria .................................................................................................................................................................... 9 Application ............................................................................................................................................................................ 10 Admission Application Disclaimer ......................................................................................................................................... 12 Background Checks ............................................................................................................................................................... 16 Fingerprint Cards ................................................................................................................................................................... 16 Essential Functions ............................................................................................................................................................... 17 Essential Functions Understanding Of Requirements ........................................................................................................... 18 Admission Application Disclaimer ......................................................................................................................................... 20 Emergency Medical Form ...................................................................................................................................................... 21 Student Contact Information................................................................................................................................................. 22

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.

ANTI-DISCRIMINATION POLICY Mohave Community College does not discriminate on the basis of race, color, ethnicity, national origin, gender, sex, age, religion, gender identity, gender expression, disability, or sexual orientation in its educational programs and activities or employment practices. Discrimination includes harassment, which includes a wide range of abusive and humiliating verbal or physical behaviors that are directed against a particular person or persons because of one of the above named qualities. This includes creating a “hostile environment” where the conduct is sufficiently severe or pervasive to alter the conditions of the person’s employment or educational experience at the College. Members of the College community have a responsibility to report discrimination and those in supervisory roles are obligated to take action to correct it. Any person found to have violated this anti-discrimination policy will be subject to appropriate disciplinary action.



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 1st, through the first Friday in June each year. 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, they do not need to complete the clinical needs and, 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:

PROGRAM CONTACT INFORMATION Please contact one of the following individuals or the program website if you have additional questions about the Medical Assisting/Phlebotomy program:

Website: www.mohave.edu Medical Assisting Information:

http://www.mohave.edu/academics/certificates/medassist/

Lori Hogue, CMA, RMA, CPT, LME Director of Medical Assisting and HIT programs

Phone: (928)302-5340 E-mail: [email protected]

Candi Lutz, CMA

Kingman, Resident Faculty Phone: 928-757-0808

E-mail: [email protected]

JoAnne Franz MS RN Bullhead, Resident Faculty

Phone: 928-704-4018 E-mail: [email protected]

MCC Connect: For Academic Advising Phone: 1-866-664-2832

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

http://www.mohave.edu/

http://www.mohave.edu/academics/certificates/medassist/

mailto:[email protected]





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

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 Medical Assisting/Phlebotomy 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 Medical Assisting 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 131 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 Medical Assisting 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.

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 hour 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.



10. PHYSICAL EXAMINATION, IMMUNIZATION AND TB TESTING REQUIREMENTS: A physical examination, proof of immunization and TB testing will be required annually. Please be aware that immunization and testing may vary depending on the clinical site that you may attend during the clinical rotation. Therefore, additional expenses may occur.

11. BACKGROUND CHECK REQUIREMENTS: Background checks are required for incoming students to insure the safety of the patients treated by the students in the clinical education program. You will be required to order your background check in sufficient time for it to be reviewed by the program coordinator. A Public Safety Level One Fingerprint Clearance Card (FCC Card) is also required. Students bear the responsibility for the cost of the Background Check and the FCC Card. For frequently asked questions about FCC Card, visit: http://www.azdps.gov/services/fingerprint/.

For additional information on background checks please go to www.mystudentcheck.com, and select Mohave Community College District from the drop-down menu. In the next drop-down menu, you will see Medical Assisting or Phlebotomy. If you have been advised of being denied entry into the program due to information on the report, you can contact Pre-Check’s Adverse Action Hotline at 800-203-1654. This is the procedure by the Fair Credit Reporting Act that allows you to see the report and to dispute the information. You can also contact [email protected] for further assistance.

12. DRUG SCREENING Each student must go through a pre-clinical course drug screen prior to beginning the first clinical course. 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.

13. MEDICAL INSURANCE It is a requirement for Mohave Community College Medical Assisting/Phlebotomy students to have medical insurance while enrolled in this program. Please contact a local insurance provider.

14. IS FINANCIAL AID AVAILABLE? Financial assistance is available to eligible students in the form of grants, scholarships, employment, or loans. Students may receive aid from one funding source or aid that may be in a package from offered multiple sources. Students may contact the financial aid office at (866)-664-2832 or visit the website at www.mohave.edu for additional information.

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

ACCEPTED INTO THE PROGRAM.

INSURANCE CODING STUDENTS DO NOT NEED TO SUBMIT AN APPLICATION OR CLINICL DOCUMENTS.

.

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

http://www.mystudentcheck.com/


http://www.mohave.edu/



MEDICAL ASSISTING PROGRAM CLINICAL NEEDS CHECK LIST This is only a checklist, please do not have the physician sign or stamp this form.

ADDITIONAL EXPENSES

AFTER A STUDENT IS ACCEPTED INTO THE PROGRAM, it is the student’s responsibility to provide proof of the following immunizations to the program secretary. Updates must be provided 30 days prior to starting each clinical practicum throughout the Medical Assisting/Phlebotomy Program. Documentation is required for proof of completion.

Note: 1. A vaccine is an injection given to make you develop immunity for Varicella, HepB or MMR. 2. A titer is a blood test, to prove that you developed that immunity.

If you were vaccinated as a child, it is possible to lose immunity. A titer is recommended to verify that you are still immune to Varicella, HepB and MMR. If you were not vaccinated, you will need the vaccine.

BACKGROUND CHECK – Pre-check form. Background check is good for the duration of the program. Some sited may require an updated background and drug screen prior or externship placement. www.mystudentcheck.com Date: ___________________________________ FINGERPRINT CLEARANCE CARD – AZ Department of Public Safety. Card is valid for 6 years. http://www.azdps.gov/services/fingerprint/ 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 – Pre-check form. Background check will include the drug screen. Follow instructions for obtaining the drug screen. www.mystudentcheck.com Date: ___________________________________

INFLUENZA VACCINE (FLU SHOT) –The seasonal flu shot protects against three or four influenza viruses. It is required for an Acute Care clinical placement or you must wear a face mask for the duration of the acute care clinical placement. Date: ________________________

ANNUAL TB TEST – If you have not had a TB Test in the past year, you will need the 2-Step TB. Annual TB test is good for 1 year. If you had a chest x-ray that is good for two years.

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.

Date: _____________________________

HEP B OR TITER – (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. HEP B is good for 7 - 10 years. Booster & Titer is recommended after 10 years. Three immunization series –

1st injection of vaccine Date: ___________________________________ 2nd injection is administered 30 days after 1st injection. Date: ___________________________________ 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) OR TITER – (if titer is low or no immunity you will need the Varicella vaccine) this vaccine is good for 10 years. Date: ___________________________________ MMR (Measles, Mumps, and Rubella) OR TITER – (if titer is low or no immunity you will need the MMR vaccine) this vaccine is good for 10 years. Date: __________________________






Resource for Immunizations:

MOHAVE COUNTY DEPARTMENT OF PUBLIC HEALTH

Health Department 2001 College Drive

Lake Havasu City, AZ 86403 Phone: 928-453-0703

Fax: 928-453-0740

There is a local Health Department in Kingman and Bullhead City. All fees are the same.

ADULT IMMUNIZATIONS OFFERED BY THE HEALTH DEPARTMENT:

*2014 Current Mohave County/Public Health pricing for adult services

TD (TETANUS/DIPHTHERIA $52.00

HEPATITIS A $64.00

HEPATITIS B $72.00

MMR $93.00

VARICELLA $131.00

MENACTRA (MENINGOCOCCAL VACCINE) $155.00

MENOMUNE (MENINGOCOCCAL VACCINE) $154.00

TWINRIX (HEPATITIS A AND B COMBINED) $92.00

RABIES (IMOVAX) $272.00

ADACEL (ADULT PERTUSSIS) T DAP $70.00

INFLUENZA $37.00

PNEUMONIA $98.00

HEP B TITER $81.00

VARICELLA TITER $87.00

MEASLES - RUBELLA TITER $158.00

RABIES TITER $118.00

HPV $178.00

SHINGLES $211.00

These services offered on sliding fee scale based upon patient income

If you are 18 years old and have no insurance coverage for vaccines, you can be seen for free on kid’s day

(Tuesday’s).

The above list is just a reference and not all immunizations listed are required



MCC ID #: ____________ Name: ____________________________________________Date: __________________

ADMISSION REQUIREMENTS

Use This Checklist to Submit 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. TRE 089 OR proof of college level reading via the Placement Test/Transcripts

4. Demonstrate an overall GPA of 2.7 or higher

5. Demonstrates a minimum of C or higher grade in all Gen Ed, MEA, NUT and HES courses

6. TRM 090/MAT 101 OR Higher Math Course or Placement score into Higher Math

7. PreCheck Negative Drug Screen (this will be submitted after acceptance to the program)

8. PreCheck Criminal Background Check (this will be submitted after acceptance to the program)

9. AZDPS level 1 Fingerprint Clearance Card (this will be submitted after acceptance to the program)

10. TEAS V Examination Result Packet

11. Medical Assisting Program Application

12. Completed Physical Form (this will be submitted after acceptance to the program)

13. Drug Screening Disclaimer Signature Page

14. Essential Functions Signature Page

15. Background and Fingerprint Signature Page

SELECTION CRITERIA

COURSES A B C Points

PREREQUISITES TRE089 & TRM 090 or MAT 101 – (Letter grade not awarded) N/A

If you have taken →→ BIO 100 3 2 1

GENERAL EDUCATION BIO 201 3 2 1

BIO 202 3 2 1

PSY 101 3 2 1

ENG 101 3 2 1

ENG 102 3 2 1

CIS 110 or higher 3 2 1

TEAS V Exam 5 points 50% to

60% 10 points 61% to

100%

RESIDENCY Points Points

County Resident 2

Arizona Resident 2

WORK EXPERIENCE Points Points

Healthcare Related: hospital, skilled nursing facility, and/or medical office; 3 or more years’ experience

7

Healthcare Related: hospital, skilled nursing facility, and/or medical office; 1 -3 years’ experience

5

ADDITIONAL COURSE COMPLETION POINTS Points Points

Completion of 5 to 6 of the above prerequisites & general education 10





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) and certificates 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:

____________________________________________________________________________________________________________

____________________________________________________________________________________________________________

____________________________________________________________________________________________________________

____________________________________________________________________________________________________________



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]


Mohave Community College * 1977 Acoma Blvd, West * Lake Havasu City, AZ 86403 * PTA Program Support 928-505-3351 MCC Form EDU 0032 (Revised 7/01/2016) Page 16 of 22


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.



Fingerprint Clearance Card:


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

(PLEASE SIGN AND RETURN WITH COMPLETED APPLICATION)


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



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 c r i t i c a l t h i n k i n g a n d p r o b l e m s o l v i n g s k i l l s f o r e f f e c t i v e p a t i e n t

m a n a g e m e n t a n d 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 per 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.



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 can 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 and a current Flu vaccine

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. Clear Background check through PreCheck and a current AZDPS Fingerprint Clearance Card 6. Current Physical Examination provided by a Medical Physician (MD), Nurse Practitioner (NP), Physician

Assistant (PA) or Doctor of Osteopathy (DO). 7. 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.





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 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.



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




EMERGENCY MEDICAL FORM

STUDENT NAME: PHONE: ____________________________________

ADDRESS: ________________________________________________________________________________

EMERGENCY CONTACT: _(RELATIONSHIP)___________________

HOME PHONE:

WORK PHONE:

CELL PHONE:

BRIEF PAST MEDICAL HISTORY:

CURRENT MEDICATIONS:

ALLERGIES:

INSURANCE CARRIER:

________________________________________________________________________________________



STUDENT CONTACT INFORMATION

It is essential that the Medical Assisting Program can contact you at any time. For us to do so, we are requiring ALL students entering our Medical Assisting Program to keep us up-to-date with all your contact information. This will allow for better communication between the Medical Assisting Department Faculty/Staff and Medical Assisting Students.

Please ASK for an update form, once you are in the program, IF any changes occur, (i.e. name change, address change, phone number change, etc.) as the Medical Assisting Department will not be issuing the update forms unless they are necessary and upon student request. This IS the students’ responsibility to get these updates turned into the Medical Assisting Department once they have occurred.

Please fill out ALL of the following REQUIRED information below. Please PRINT LEGIBLY so that we don’t make any mistakes while updating your Medical Assisting file. Thank you for your assistance.

Name: _______________________________________________________________________________________

Address: ______________________________________________________________________________________ City State Zip

( ) ( ) ( ) (Cell Phone) (Home Phone) (Work Phone)

Email Address: _____________________________________________________________

Student ID #: _____________ Campus: _______________ Course: MEA P ro g ra m (BHC, LHC, KNG, NMC)

Date: ______________________ Birthdate: ______________________________________ Emergency Contact:

WAYS OF RETURNING FORM

MAIL TO: Mohave Community College

Medical Assisting Program

1977 Acoma Blvd W

Lake Havasu City, AZ 86403

EMAIL TO: [email protected]

Or, An MCC Student Service office can scan the application to: Lori Hogue

ATTENTION all Medical Assisting Program Students

STUDENT CONTACT INFORMATION


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