Faculty/Student Orientation Acknowledgement Form*
The following faculty and students acknowledge that they have read and understand the orientation material contained on the Standard Hospital Orientation for Faculty and Students website. Furthermore, faculty and students acknowledge that they are CPR certified, and are in compliance with requirements relevant to a negative TB skin test or chest x-ray, rubella, varicella, and hepatitis B vaccine (or have on file a declination statement).
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_______________________________ ______________________________ Faculty Name School
_______________________________ ______________________________ Title Semester/Year
Please Indicate Faculty Members with an asterisk *(Return form to UMC)