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<br />Clinical Affiliation Agreement <br />Page 4 of 6 <br /> <br />any intern for participation in an Experience at Service Agency who has a criminal <br />record. <br />F. Conduct drug & alcohol screening on all interns assigned to clinical rotations at the <br />Service Agency under this agreement. The drug screening should include at least the <br />following: AMP (amphetamine), BAR (barbiturates), COC (cocaine), THC (marijuana) <br />OPI (opiate) and PCP (Phencyclidine). The results will be available for review by the <br />Service Agency. <br />G. Maintain a preceptor-intern ratio in accordance with North Carolina Office of EMS and <br />other accrediting and approving bodies. <br />H. Schedule clinical experience with the Service Agency point of contact two to four weeks <br />prior to the clinical opportunity. <br />I. Require interns to wear the adopted EMS program uniform and ID badge. <br />J. Require interns to comply with policies and procedures regarding personal appearance <br />and hygiene while participating in clinical opportunities. <br />K. Require interns absent from the clinical area to inform the clinical preceptor or <br />supervisor no later than one hour prior to the assignment. <br />L. Dismiss any intern from the Service Agency who presents problems in physical or <br />emotional health, and/or demonstrates behaviors which conflicts with safety essential to <br />clinical practice. <br />M. Plan the total curriculum as guided by the North Carolina Office of EMS and other <br />accrediting and approval bodies. The preceptor will have the primary responsibility for <br />the appropriate assignment, supervision, and evaluation of interns in the clinical <br />opportunity to carry out the purposes and functions of the program goals. <br />N. Collaborate with designee of the Service Agency for input into planning of curricula and <br />clinical learning experiences. <br />O. Require all interns to obtain and maintain professional liability insurance, which pays up <br />to $2 million for each claim up to a total of $5 million in any one year. <br />P. Require interns to complete a Blood-borne Pathogen Program compliant with 29 CFR <br />1090.1030. This program shall include: <br />i. Training on blood-borne pathogens to include Standard Precautions prior to <br />clinical experiences. (29 CFR 1910.1030(g)(2)) <br />Docusign Envelope ID: 3F418FE8-2F1F-4667-BBBD-B548F8E3D7F4