Date Form Placed Into Student Electronic File / Location / Uploaded By / Title / Date Uploaded: _______________________________________________________ Section VI. Program Record Verification Verification checklist: student immunization compliance verification completed; requi red health- screening compliance verification completed; clinical -phase/SCPE compliance verification completed; applicable clinical - site requirements verified; student authorization for release obtained, when required; form securely placed in the student’s electronic NLU PA Program file. Verified By / Title / Signature / Date: _______________________________________________________ Record Maintenance and Confidentiality: This form is maintained in a secure NLU University-approved electronic platform using individual user IDs, password-protected and role-based access, and applicable NLU information-security and privacy requirements. Detailed medical records, diagnoses, treatment information, and provider notes are not maintained or reviewed by PA Program facul ty or staff except as specifically authorized by law, institutional policy, or the student’s written permission. Form Number: PA-A3.18-001. Document Owner: NLU PA Program Director. Review Cycle: Annual or sooner if required by changes in ARC-PA Standards, NLU policy, applicable law, or clinical education requirements.
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