NLU PA Program — Didactic Year Handbook
clinical placement or of clinical-site health and safety requirements), with an effective date and, if applicable, an expiration date.
Student Name / NLU Student ID Number: _______________________________________________________
Authorized Recipient (Clinical Affiliate/Organization, Contact/Department): _______________________________________________________
Authorization Effective Date / Expiration Date, if applicable: _______________________________________________________
Student Signature / Date: _______________________________________________________
Section V. Electronic Student File Documentation
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; required 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 faculty 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.
Student Remediation Documentation, Tracking, and Annual Audit Form
ARC-PA Alignment: Standard A3.16(c), A3.16(d), A3.16(e), and A3.16(f). Related Program Processes: Student Performance, Student Progression, Remediation, Professionalism, Academic Records, and Program Completion. Record Classification: Confidential Student Educational Record. This is the Program’s official remediation record and supersedes the quick-reference summary above whenever the two forms would conflict.
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