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2010‐2011 Pharm.D. APPE Rotation Requirements
Below is a checklist of the health care requirements that students are required to meet to be allowed to participate in APPEs. It will be necessary for each student to provide proof of meeting each of the requirements to the APPE director through Mrs. Kathy Zember by the indicated due dates. Please use the physical examination form entitled Experiential Program Health Data Form which is attached.
Informed Consent/Release Form/Confidentiality Statement
In addition, students are required to sign the Hepatitis B Vaccine Informed Consent (in the appropriate section), the Waiver and Acknowledgment Informed Consent, Medical Information Release Form, and the APPE Confidentiality Statement.
All students who have taken PHPR 4420 are certified. If you were certified outside of the class, you must provide documentation.
Students are required to have professional malpractice liability insurance coverage of at least $1,000,000/$3,000,000 which is covered through APPE lab fees.
Submit all forms to Kathy Zember by February 28.
- Health Requirements Checklist Form – Experiential Program
- Experiential Program Health Data Form
- Hepatitis B Informed Consent Form
- APPE Confidentiality Statement Form
- Medical Information Release Form
- CPR Certification proof, if not certified in PHPR 4420
- Background Check Information & Release Form
- Understanding of APPE Policy and Procedures Form (have read and understand the PharmD Manual)
Ohio Internship License
In order to enroll in APPE rotations, all students must have an active Ohio internship license. After rotation assignments have been finalized, students must obtain internship licenses for any other state in which they will be practicing.