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Observation Program Application

By completing and submitting the application below, you agree to the following:

  1. I understand that the observation provided is done to assure legitimate access to Confluence Health (CH) hospitals
    and clinics for educational purposes only.
  2. I understand that all information about patients, whether it is medical or personal, is absolutely confidential.
  3. I understand that as an observer, regardless of background and training, I may not have any physical patient contact, perform any medical procedures, or have unsupervised access to patients.
  4. I agree to hold harmless Confluence Health from any present and future liability and/or damages for injuries arising from or growing out of this observational experience.
  5. I agree that should I become ill or injured while on the premise of CH, I can be treated at CH at my own expense.
  6. I agree to adhere to the CH appearance and dress code policy.
  7. I agree to adhere to parking policies and rules specific to the observation site.
  8. I agree to return the identification badge to the provider or employee observed on completion of the observation.
  9. I agree to contact the provider or employee I will observe in the event I am unable to attend my scheduled observation date and time.
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