Informed Consent

TULSA COMMUNITY COLLEGE

PHYSICAL THERAPIST ASSISTANT PROGRAM

Informed Consent

I  (insert student name) wish to be a participant in the Physical Therapist Assistant Program at Tulsa Community College.

I understand that the program will include academic, laboratory and clinical work performed in the classroom, laboratory, hospital or other clinical facilities and will include direct care or exposure to clients with a variety of illnesses and diseases. I understand that I may be exposed to disease carrying bacteria, and substances used to kill these organisms.

I understand that as a student in the program, I consent to participate in human subject demonstration and studies in the classroom, laboratory and clinical facilities as part of the educational process. I understand that I may also be videotaped, audio taped, or photographed in the course of this program. Participation in said activities necessitates the wearing of appropriate and specific clothing. Laboratory clothing for males include shorts and T-shirts and the males will be asked to expose their upper torso; females need shorts, T-shirts, and a sports bra.

I understand that I am responsible for my own transportation to and from academic and clinical experiences and that out of town travel or residence will be necessary to complete clinical education. I also understand that clinical attendance is mandatory and all absences are considered unexcused and that participation in clinical education may also require drug testing and criminal background information.

I understand that I must maintain good health and notify the school of any physical or mental limitations/problems that may affect my performance. I must submit proof of immunizations, a yearly negative examination for TB, CPR certification, and a background check.  In addition, some clinical facilities may require a drug screening, and if so the cost may be incurred by me. I also understand that if requested by the school, I must provide a medical release from my physician to resume the program.

I understand that I must be able to interact effectively and build relationships with all individuals.

I understand the physical requirements of this program to be strenuous. I must be able to:

  1. achieve Course "C" CPR certification
  2. stand for 8 hours
  3. sit for 8 hours
  4. perform skills requiring manual dexterity, fingering and feeling
  5. maintain good standing balance on all surfaces
  6. administer manual exercises
  7. perform skills requiring walking
  8. safely transfer patients from all surfaces
  9. measure vital signs
  10. make simple mechanical adjustments and repairs of therapy equipment
  11. lift up to 20# frequently
  12. lift up to 50# occasionally
  13. squat, stoop, kneel and/ or crawl
  14. transport patients with wheelchairs and carts by pushing and pulling

I understand that I will be issued a Physical Therapist Assistant Program Student Handbook, a Clinical Education Student Handbook and the Student Code of Responsibility and Conduct for Tulsa Community College at the beginning of the fall term. I must adhere to all rules and regulations of the school and clinical sites.

In consideration of being permitted to participate in the Physical Therapist Assistant Program, I understand that it is my responsibility to seek academic accommodation services. The faculty may be able to accommodate me if a formal request is made and official certification of the disability is completed.

I hereby certify that I have read the entire document, that I am fully familiar with the contents of this document and that I fully understand its terms. Any questions that I have about this program and the contents of this document have been fully explained to my satisfaction. I am over 18 years of age.

Student Signature: _________________

Parent Signature, if student is a minor:  _____________________

Date:  ____________

AttachmentSize
PTA Informed Consent 2014.pdf150.98 KB
ShareThis

TCC