| This certifies that _____________________________________is
a registered fourth year medical student in good standing at __________________________________,
which is an LCME or AOA accredited institution, and is covered by
personal health insurance and medical liability insurance, has completed
OSHA/universal precautions training and has permission to study
at Driscoll Children’s Hospital during the above period. In
addition, the student has completed the appropriate HIPPAA training
at out institution.
| __________________________________ |
|
(_______)_________-__________________ |
| Academic Dean (print or type) |
|
Area code and phone number |
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|
__________________________________ |
|
______________________, ____________ |
| Signature |
|
Date |
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