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 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.