UNIVERSITY OF SOUTH ALABAMA
COLLEGE OF NURSING
December 13, 2011
Clinical Agency Affiliations and Locations
Alabama
Agency Name Agency Requirements
15 Place
Mobile, Alabama
42nd Medical Group
Maxwell Air Force Base, Alabama
Alabama Department of Public Health,
(Alabama inclusive)
Alabama Department of Rehabilitation
Services
Mobile, AL
Allen Memorial Home
Mobile, Alabama
AltaPointe Health Systems, Inc. (formerly
Mobile Mental Health)
Mobile, Alabama
Baldwin County Mental Health
Fairhope, Alabama
Baldwin County Public Schools Faculty must notify school prior to clinical experience
Fairhope, Alabama
Baptist Medical Center South (includes Baptist Students must complete required training before beginning
training and sign an individual agreement with agency.
Medical Center East and Prattville Baptist
Hospital)
Montgomery, Alabama
Beverly Healthcare
Foley, Alabama
BMA of Alabama (Dialysis Outpatient Clinic)
Mobile, Alabama
Brookwood Health Services, Inc. BSN students: Request Attachments A-C prior to clinical. They
are Statement of Responsibility, Confidentially Statement,
Birmingham, Alabama
Background Screening Attestation.
NP students: Complete Exhibits A-C prior to clinical. Students
must obtain and maintain commercial general liability
insurance with an insurer approved by Brookwood. Such
coverage shall have limits of at least $1,000,000 per
occurrence and shall not be cancelable except upon 30 days'
prior written notice to us and to Brookwood. Students must
provide a copy of their certificate of insurance to us and to
Brookwood as evidence of said coverage.
Camp Grace, Inc.
Mobile, Alabama
Cathedral Place Apartments
Mobile, Alabama
Central Plaza Towers
Mobile, Alabama
Children’s Hospital of Alabama Nursing Preceptor & NP Agreement
Exhibit A (along with other forms) to be completed by faculty and
Birmingham, Alabama student prior to placement.
UNIVERSITY OF SOUTH ALABAMA
COLLEGE OF NURSING
December 13, 2011
Clinical Agency Affiliations and Locations
Children’s Rehab Services
Mobile, Alabama
Coastal Hospice Care, Inc.
Saraland, Alabama
Community Action Agency Head Start of
Baldwin County
Daphne, Alabama
Covenant Hospice
Daphne, Alabama
DCH Regional Medical Center
Tuscaloosa, Alabama
Dumas Wesley Community Center
Mobile, Alabama
East Alabama Medical Center
Opelika, Alabama
Enterprise Clinic, LLC (d/b/a Hartford Family Students must complete Addendum 1 & 2. Nurse
Medicine) Practitioner must complete Addendum 3, 4 and 5.
Hartford, Alabama
Fayette Medical Center
Fayette, Alabama Paper work under DCH
Foley Hospital Corporation d/b/a South Students must submit to substance abuse testing every 12
months (to test for presence of alcohol, drugs, or other
Baldwin Regional Medical Center controlled substances).
Foley, Alabama
Fox Army Health Center
Redstone Arsenal, Alabama
Franklin Primary Health Center, Inc.
Mobile, Alabama
Goodwill Easter Seals Child Development
Center
Mobile, Alabama
Gordon Oaks Healthcare
Mobile Alabama
Healthsouth Rehab Corporation
Mobile, Alabama
Huntsville Hospital
Huntsville, Alabama
IMC-Diagnostic & Medical Clinic, P.C.
Mobile, Alabama
Jackson Hospital
Montgomery, Alabama
Little Sisters of the Poor Home for the Aged,
Inc.,
Mobile, Alabama
Lyster U.S. Army Community Hospital Training for a Nursing Masters Degree
Fort Rucker, Alabama
Marengo Family Health Center
Demopolis, Alabama
UNIVERSITY OF SOUTH ALABAMA
COLLEGE OF NURSING
December 13, 2011
Clinical Agency Affiliations and Locations
Marshall Health System
Boaz, Alabama
Mercy Medical
Daphne, Alabama
Mobile County Health Department
Mobile, Alabama
Mobile County Public Schools
Mobile, Alabama
Mobile Infirmary Association (includes: Mobile
Infirmary Medical Center, North Baldwin Infirmary,
Infirmary West, Infirmary LTAC Hospital, E.A. Roberts
Alzheimer’s Center, Thomas Hospital, & Northside Clinic)
Mobile, Alabama
Mobile Nursing and Rehabilitation Center, LLC
Mobile, Alabama
Mobile Ob-Gyn, P.C.
Mobile, Alabama
North Baldwin Infirmary
Bay Minette, Alabama
Northport Medical Center
Northport, Alabama (paperwork under DCH)
Our Neighborhood Healthcare Clinic
Mobile, Alabama
Pediatrics and Adolescent Medicine PC
Mobile, Alabama
Poarch Band Creek Indians Health
Department
Atmore, Alabama
Princeton Baptist Medical Center,
Birmingham, Alabama
Providence Hospital
Mobile, Alabama
Saad’s Health Care
Mobile, Alabama
Saraland City School System
Saraland, Alabama
Searcy Hospital
Mt. Vernon, Alabama
Seton Medical Management, Inc.
Mobile, Alabama
South Baldwin Family Practice, LLC
Foley, Alabama
Southeast Alabama Medical Center
Dothan, Alabama
Springhill Memorial Hospital
UNIVERSITY OF SOUTH ALABAMA
COLLEGE OF NURSING
December 13, 2011
Clinical Agency Affiliations and Locations
Mobile, Alabama
St. Vincent’s Health System Students must sign Confidentiality Statement prior to beginning
clinicals. Clinical faculty please review manual for student
Birmingham, Alabama orientation requirements Select link here:
http://www.stvhs.com/student
Thomas Hospital
Fairhope, Alabama
Triad of Alabama, LLC d/b/a Flowers Hospital Faculty shall review Addendum 1 & 2 with student prior to
student’s clinical rotation.
Dothan, Alabama
Trinity Medical Center (formerly Montclair
Baptist Medical Center)
Birmingham, Alabama
University of Alabama -Birmingham Hospitals
Birmingham, Alabama
University of Alabama, College of Community
Health Sciences, (UMC)
Tuscaloosa, Alabama
University of Alabama (UAB) Montgomery (Includes-UAB Ambulatory Care Internal Medicine Clinic)
Internal Medicine Residency Program
Montgomery, Alabama
University of South Alabama Hospitals
Mobile, Alabama
USA Mitchell Cancer Institute
Mobile, Alabama
Central Alabama Veterans Healthcare System BSN and MSN
Montgomery and Tuskegee Alabama
VA Medical Center of Birmingham BSN-MSN
Birmingham, Alabama
VA Medical Center of Tuscaloosa, AL BSN and MSN
Tuscaloosa, Alabama
Victory Health Partners
Mobile, Alabama
Westminister Village
Spanish Fort, Alabama
Whatley Health Services
Tuscaloosa, Alabama
Alaska
Agency Name Agency Requirements
3rd Medical Group Attachment 1 and 2 for Trainee Agreement Addendum
UNIVERSITY OF SOUTH ALABAMA
COLLEGE OF NURSING
December 13, 2011
Clinical Agency Affiliations and Locations
Elmendorf AFB, Alaska
Providence Health & Services – Washington Non-employees must: complete an Alaska background check;
orientation prior to beginning clinicals.
d/b/a Providence Health & Services Alaska
Region Faculty: Must provide agency with a list of students before they
Anchorage, Alaska begin clinicals.
Arizona
Agency Name Agency Requirements
Phoenix Children’s Hospital Student must complete Attachments B & C prior to beginning
clinicals.
Phoenix, Arizona
University of Arizona, College of Nursing Student must be approved prior to beginning clinicals
Tucson, Arizona
VA Phoenix Healthcare System
Phoenix, Arizona
Arkansas
Agency Name Agency Requirements
Arkansas Children’s Hospital
Little Rock, Arkansas
Arkansas Department of Health & Human Students attachments 1 & 2 must be completed prior to starting
clinicals. See course coordinator.
Services (Arkansas inclusive) Arkansas Board of Nursing must be notified by faculty of
student name, licenses number, preceptor information, clinical
site, course of enrollment and number of clinical hours.
Central Arkansas Veterans Healthcare System BSN Degree, RN-BSN, RN-MSN
Arkansas Board of Nursing must be notified by faculty of
Little Rock, Arkansas student name, licenses number, preceptor information, clinical
site, course of enrollment and number of clinical hours.
Fort Smith HMA, LLC d/b/a Sparks Health Nursing students wishing to participate under this Agreement
must contact Theresa Phillips in Human Resources 479-441-
System 5458 to set up an appointment to begin the screening and
Fort Smith, Arkansas orientation process.
Arkansas Board of Nursing must be notified by faculty of
student name, licenses number, preceptor information, clinical
site, course of enrollment and number of clinical hours.
UNIVERSITY OF SOUTH ALABAMA
COLLEGE OF NURSING
December 13, 2011
Clinical Agency Affiliations and Locations
California
Agency Name Agency Requirements
Kaiser Foundation Hospitals and the Nurse Practitioner Agreement
Permanente Medical Group, Inc., California
HOSPITALS
Hayward, San Rafael, Oakland, Santa Clara, Redwood City,
Santa Rosa, Richmond, South Sacramento, Roseville, South
San Francisco, Sacramento, Vallejo, San Francisco, Walnut
Creek, San Jose
MEDICAL OFFICES
Antioch, Mountain View, Davis, Petaluma, Fairfield, Pleasanton,
Fremont, Rancho Cordova, Fresno, Richmond, Gilroy, Roseville,
Martinez, San Jose, Novato, Stockton, Napa, Vacaville, Milpitas
Northbay Healthcare Group d/b/a Northbay
Medical Center and Northbay Vaca Valley
Hospital
Fairfield, California
Sutter General Hospital
Sacramento, California
Union County Health Department Students must complete appendices prior to clinicals.
Monroe, North Carolina
VA Greater Los Angeles Healthcare System Master of Science
Los Angeles, California
Colorado
Agency Name Agency Requirements
Centura Hospitals in Colorado
Englewood, Colorado
Evans Army Community Hospital
Fort Carson, Colorado
VA Medical Center of Grand Junction MSN students
Grand Junction, Colorado
VA Hospital Denver
Denver, Colorado
Connecticut
UNIVERSITY OF SOUTH ALABAMA
COLLEGE OF NURSING
December 13, 2011
Clinical Agency Affiliations and Locations
Agency Name Agency Requirements
Naval Health Clinic New England Coordinators please see contract attachments.
Naval Branch Health Clinic
Groton, Connecticut
Deleware
Agency Name Agency Requirements
Nemours-Alfred I. DuPont Hospital for
Children
Wilmington, DE
Florida
Agency Name Agency Requirements
Baker County Health Department
Macclenny, Florida
Baptist Health Care Corporation Students please request Exhibit A and B prior to starting
clinicals. Must be completed before clinicals.
Pensacola, Florida
Includes: Baptist Hospital, Pensacola, FL
Gulf Breeze Hospital, Gulf Breeze, FL
Atmore Community Hospital, Atmore, AL
Baptist Medical Group, Pace, FL
Bay County Health Department
Panama City, Florida
Bay Medical Center
Panama City, Florida
Children’s Med Services, Florida Department
of Health
Panama City, Florida
Citrus County Health Department
Lecanto, Florida
Eglin Air Force Base, 96th Medical Undergraduate and graduate nursing degree programs–
Students must sign the Trainee Agreement Addendum
Group/SGSF
Eglin AFB, Florida
Escambia County Health Department
Pensacola, Florida
Florida Department of Health
UNIVERSITY OF SOUTH ALABAMA
COLLEGE OF NURSING
December 13, 2011
Clinical Agency Affiliations and Locations
Includes: Holmes County Health Dept.
Bonifay, Florida
Florida Hospital Student must be N-95 respirator fit tested prior to attending
clnical. Testing can be done for $25 at the Agency clinic.
Orlando, Florida
Florida State Hospital
Chattahoochee, Florida
Fort Walton Beach Medical Center Student must take Compliance test from agency prior to
beginning clinical rotation. Also exhibits must be completed.
Ft. Walton Beach, Florida Agency requires modified Letter of Notification – faculty please
contact CON contracts department.
Holmes County Department of Health
Bonifay, Florida
Holmes Regional Medical Center **Faculty please see me regarding “specific responsibilities”
Melbourne, Florida
Kindred Healthcare System
Green Cove Springs, Florida
Lakeview Center, Inc.
Pensacola, Florida
Lakewood Ranch Medical Center
Bradenton, Florida
Lee Memorial Health System
Cape Coral, Florida
Madison Nursing Center
Madison, Florida
Memorial Healthcare Group, Inc., d/b/a Student must complete Exhibits A-C prior to beginning clinicals.
Memorial Hospital
Jacksonville, Florida
Miami Children’s Hospital Attachment A must be submitted on an annual basis not less
than 60 days prior to the commencement of each period of
Miami, Florida clinical assignment. Faculty please see CON Contracts Dept for
Attachment A.
Moffitt Cancer Center RN-BSN, BSN, RN-MSN, and DNP programs.
Tampa, Florida Schedule 4.8 Screenings and Vaccination
Schedule 4.9 Student Letter Agreement, must be completed by
student.
Munroe Regional Medical Center Student must contact Workforce Development Coordinator with
Munroe to complete orientation packet prior to beginning
Ocala, Florida clinicals.
Naples Community Hospital, NCH Healthcare
Naples, Florida
Naval Hospital Contract includes: Allied Health students
Students are required to complete a confidentiality statement
Pensacola, Florida prior to clinical experience (See faculty)
Nemours Foundation (includes Children’s
Clinic in Destin, FL)
Pensacola, Florida
Neonatology Associates of Atlanta, P.C.
(Pediatrix)
Sunrise, Florida (corporate office)
North Okaloosa Medical Center
UNIVERSITY OF SOUTH ALABAMA
COLLEGE OF NURSING
December 13, 2011
Clinical Agency Affiliations and Locations
Crestview, Florida
Oak Hill Hospital Students must complete Exhibits A & B prior to beginning
clinical rotation. USA CON must complete Exhibit C on behalf of
Brooksville, Florida student(s).
Orlando Health, Inc. Schedule B Requirements for Participants on file
Orlando, Florida
Okaloosa County Health Dept.
Fort Walton Beach, Florida
Palm Beach County Health Department,
Florida
West Palm Beach, Florida
Sacred Heart Health System Students must review Exhibit A and complete Application for
Residents and Students prior to starting clinicals. See course
Pensacola, Florida coordinators.
Santa Rosa Public Health Department
Milton, Florida
Shands Jacksonville Medical Center ALL REQUESTS FOR CLINICAL ROTATIONS MUST COME
FROM FACULTY. Faculty should contact Sophia Akley,
Jacksonville, Florida Education Director, at (904) 244-1925 and she will provide
Shands’ orientation packet. Students must have photo student
ID and complete Shands’ orientation prior to beginning clinicals.
Exhibit A requirements from student and faculty.
Shands Teaching Hospital and Clinics d/b/a Students must complete Exhibit A before starting clinicals.
Shands at the University of Florida (Shands at
Vista and Shands Rehab Hospital)
Gainesville, Florida
South Broward Hospital District d/b/a Memorial Masters in Nursing Program, Neonatal NP
Healthcare System
Hollywood, Florida
Tallahassee Memorial HealthCare, Inc. Students must complete TMH’s attachments and orientation
prior to beginning clinicals.
Tallahassee, Florida
Tampa General Hospital (Florida Health
Science Center) (including Florida Gulf to
Bay Anesthesiology Associates, PA)
Tampa, Florida
Twin Cities Hospital
Niceville, Florida
University of Florida, College of Medicine,
OBGYN Department
Pensacola, Florida
James A. Haley Veterans Hospital RN-BSN, Master of Science, Doctor of Nursing Practice
Tampa, Florida
VA Healthcare Center of Bay Pines BSN, MSN, DNP
Student must contact agency to be fingerprinted 1 month prior to
Bay Pines, Florida rotation. Student cannot begin until results are back.
Veterans Affairs North Florida/South Georgia RN-BSN/BSN & MSN
UNIVERSITY OF SOUTH ALABAMA
COLLEGE OF NURSING
December 13, 2011
Clinical Agency Affiliations and Locations
Health System
Gainesville, Florida
Walton County Health Department
Defuniak Springs, Florida
West Florida Hospital
Pensacola, Florida
White-Wilson Medical Center Advanced Registered NP Agreement (agency requires separate
agreement for each student). FACULTY – please distribute
Fort Walton Beach, Florida WWMC’s Protocol to student. Students should inquire at
Administration (850-863-8131) to determine if a
physician/specialty is available. Students should NOT
contact physicians themselves; Administration will contact
the physician for the student.
Wolfson Children’s Hospital
Jacksonville, Florida
Georgia
Agency Name Agency Requirements
Appling Health Care System
St. Baxley, Georgia
Children’s Healthcare of Atlanta Students must complete Exhibits A, B-1, and C prior to clinical.
Atlanta, Georgia
Dekalb Medical Center Nurse Practitioner Agreement
Decatur, Georgia
Doctors Hospital of Augusta Students must complete Exhibit B as well as the Statement of
Responsibility prior to starting clinicals (see faculty)
Augusta, Georgia
Dwight David Eisenhower Army Medical
Center
Fort Gordon, Georgia
Emory University Hospital includes:[Emory Students please request attachments from the course
Crawford Long Hospital, Wesley Woods Center, Emory coordinator. These documents must be completed prior to
University Orthopedic and Spine Hospital, The Emory Clinic, clinicals.
Emory Children’s Center]
Atlanta, Georgia
Georgia Dept. of Health, West Central Health
District
Columbus, Georgia
Georgia Health Science Health Inc. (formerly Please contact Angela McIntosh, Clinical Nurse Educator, at
(706) 721-0305 or via email to amcintosh@georgiahealth.edu
Medical College of Georgia)
Augusta, Georgia
Georgia Southern University
Statesboro, Georgia
Grady Health System Students notify faculty prior to starting clinicals. Faculty should
see contract person regarding exhibits for students to complete.
Atlanta, Georgia
UNIVERSITY OF SOUTH ALABAMA
COLLEGE OF NURSING
December 13, 2011
Clinical Agency Affiliations and Locations
Gwinnett Hospital System, Inc. NNP students only – preceptor Dr. Leslie Leigh;
Students must review Exhibit “A” Permitted Activities of the
Lawrenceville and Duluth, Georgia Student
Harbin Clinic
Rome, Georgia
Health District 8, Unit 2 (Southwest Georgia Health District) (encompasses clinical
facilities in Georgia counties of Baker, Calhoun, Colquitt,
Albany, Georgia Decatur, Dougherty, Early, Grady, Lee, Miller, Mitchell,
Seminole, Terrell, Thomas & Worth)
Hospital Authority of Valdosta and Lowndes
County, GA d/b/a South Georgia Medical
Center
Martin Army Community Hospital BSN and graduate students
Fort Benning, Georgia
Meadows Healthcare Alliance Only allows students into agency’s Wellness Center for sports
medicine clinicals.
Vidalia, Georgia
Meadows Regional Medical Center
Vidalia, Georgia
Memorial Hospital University Medical Center Student must complete attachments A through G and
Verification of Student Information
Savannah, Georgia
Mercy Care Services, Inc.
Atlanta, Georgia
Northeast Georgia Medical Centers, Inc. Graduate Students
(Northeast Georgia Health System)
Gainesville, Georgia
Northside Hospital
Atlanta, Georgia
Patient Care Services
Decatur, Georgia
Piedmont Healthcare, Inc. Must provide student placement coordinator a statement that
student has a negative drug screen and background check.
Atlanta, Georgia Student must complete Exhibit B “Participant Agreement” and
Exhibit C “Confidentiality Agreement”
Planned Parenthood of Georgia, Inc.
Atlanta, Georgia
St. Francis Hospital, Inc. Students must complete Exhibits A & B prior to beginning
clinicals
Columbus, Georgia
St. Joseph’s /Candler Health System Acute Care and Emergency Nurse Practitioners only
Savannah, Georgia
Saint Joseph’s Hospital of Atlanta, Inc. Students must complete Exhibit B prior to starting clinicals.
Faculty and student must read and sign “Standards of Conduct”
Atlanta, Georgia form. Faculty should contact Contract person at CON.
Southeastern Regional Primary Care
Corporation
Vidalia, Georgia
Tanner Medical Center, Inc.
Carrollton, Georgia
Tenet Health System GB, Inc. (dba Atlanta Student attachments required prior to starting clinicals. Please
request Exhibit A and B from faculty.
UNIVERSITY OF SOUTH ALABAMA
COLLEGE OF NURSING
December 13, 2011
Clinical Agency Affiliations and Locations
Medical Center)
Atlanta, Georgia
The Medical Center, Inc. Student must carry their own occurrence-type general and
professional liability insurance coverage in amounts not less
Columbus, Georgia than $1,000,000 per occurrence and $3,000,000 annual
aggregate.
United HealthCare Services, Inc. Students must complete attachments prior to clinicals-See
faculty
d/b/a Evercare Georgia,
Norcross, Georgia
VA Medical Center of Atlanta MSN in Gerontology NP
RN-BSN-MSN
Atlanta, Georgia
VA Medical Center of Carl Vinson NP: Masters Program
Dublin, GA
VA Medical Center of Charlie Norwood Nursing (MSN-GNP Degree Programs)
DNP Students
Augusta, Georgia
WellStar Health System, Inc. Only WellStar employees are eligible. Students must complete
an orientation packet prior to beginning any clinical rotation.
Marietta, Georgia
West Georgia Medical Center
LaGrange, Georgia
Hawaii
Agency Name Agency Requirements
Hawaii Pacific Health Students must review Exhibit “A” Standards of Conduct
Honolulu, Hawaii
Kaiser Foundation Hospitals, Hawaii Region
and the Kaiser Foundation Health Plan Inc.,
Hawaii Region
Tripler Army Medical Center
Honolulu, Hawaii
VA Pacific Islands Health Care System MSN students only
Honolulu, Hawaii
Idaho
Agency Name Agency Requirements
Boise VAMC
Boise, Idaho
Eastern Idaho Health Services
UNIVERSITY OF SOUTH ALABAMA
COLLEGE OF NURSING
December 13, 2011
Clinical Agency Affiliations and Locations
Idaho Falls, Idaho
Idaho Department of Health and Welfare State
Hospital North
Orofino, Idaho
St. Alphonsus Physicians Services, Inc. Students must complete Attachments prior to starting clinicals—
See faculty
Boise, Idaho
Illinois
Agency Name Agency Requirements
Northwestern Memorial Hospital Students must complete Exhibit 1 prior to clinicals.
Chicago, Illinois
VA Medical Center of Marion, IL Master of Science
Marion, Illinois
Indiana
Agency Name Agency Requirements
Floyd Memorial Hospital and Health Services
New Albany, Indiana
Scott Memorial Hospital
Scottsburg, Indiana
Iowa
Agency Name Agency Requirements
Mercy Medical Center Exhibit A must be completed and signed by student.
Des Moines, Iowa
VA Central Iowa Health Care System CNL students only
Knoxville and Des Moines Divisions
Kansas
Agency Name Agency Requirements
UNIVERSITY OF SOUTH ALABAMA
COLLEGE OF NURSING
December 13, 2011
Clinical Agency Affiliations and Locations
Sedgwick County Health Department
Wichita, Kansas
University of Kansas Hospital Authority Students must complete Exhibit B prior to beginning clinicals.
Agency requires annual TB testing.
Westwood, Kansas Faculty: Agency requires list of students, clinical units to be
used, detailed written educational goals and objectives for each
clinical experience.
VA Medical Center of Eastern Kansas MSN and NP Degree Programs
Leavenworth & Topeka, Kansas
Kentucky
Agency Name Agency Requirements
Baptist Healthcare System, Inc. d/b/a Central Student must sign Statement of Understanding and
Confidentiality Agreement.
Baptist Hospital
Lexington, Kentucky
Blanchfield Army Community Hospital
Fort Campbell, Kentucky
Jewish Hospital & St. Mary’s Healthcare, Inc. Exhibits A & B must be completed prior to beginning clinical
rotation. In addition, School must verify negative status of
d/b/a Jewish Hospital Kentucky Board of Nursing Abuse Registry check prior to
Louisville, Kentucky commencement of the clinical experience.
Our Lady of Bellefonte Hospital
Ashland, Kentucky
Trover Foundation/Trover Health Services Students must provide copies of all immunization records to the
site Clinical Education coordinator
Madisonville, Kentucky
University of Kentucky Medical Center
Lexington, Kentucky
University Medical Center, Inc. d/b/a University Students must fulfill requirements as outlined in Exhibit A and
sign Exhibit B (Statement of Understanding and Confidentiality
of Louisville Hospital/James Graham Brown Agreement)
Cancer Center
Louisville, Kentucky
Louisiana
Agency Name Agency Requirements
Baton Rouge General Medical Center Physical Therapy, Occupational Therapy and Nursing Students
contract
Baton Rouge, Louisiana
Children’s Hospital
New Orleans, Louisiana
Christus Health Northern Louisiana
UNIVERSITY OF SOUTH ALABAMA
COLLEGE OF NURSING
December 13, 2011
Clinical Agency Affiliations and Locations
Shreveport, Louisiana
Dauterive Hospital
New Iberia, Louisiana
East Jefferson General Hospital Nursing Preceptor Agreement Only.
Faculty needs to provide roster of students, etc.
Metairie, Louisiana *Students must submit a letter to CNO regarding goals outlined
by the school and the student for the practicum and a copy of
the student’s current vitae.
*Graduate students must be interviewed by EJGH oversight
committee members to discuss mutual goals and objectives.
*Students must have preceptor selected by Director of CNKR
and meet with preceptor prior to starting practicum.
Health Care Centers in Schools
Baton Rouge, Louisiana
Iasis Glenwood Regional Medical Center, LP Students must complete Exhibit A, “Confidentiality Statement”
prior to beginning clinical rotation.
West Monroe, Louisiana
Iberia Medical Center (Jeanerette Rural Health
Center)
New Iberia, Louisiana
Lakeland Medical Center
New Orleans, Louisiana
Lallie Kemp Medical Center
Independence, LA
Leonard J. Chabert Medical Center –LSU
Hospitals Health Care Services Division
Houma, Louisiana
LSU Health Sciences Center Faculty must submit in writing their requests for clinical sites for
each rotation. Contact USA contract dept for agency contact
Shreveport, Louisiana info.
Students must provide verification of negative TB skin test
within the past 12 months or follow up negative chest x-ray
result.
Medical Center of Louisiana at New Orleans or *Name Alert* Due to Hurricane Katrina, this site has a new
name (Louisiana State University Interim Hospital)
(LSU Interim Hospital)
New Orleans, Louisiana
North Oaks Health System (includes North Students must notify agency clinical coordinator prior to starting
clinicals Must be in compliance with Louisiana State Board of
Oaks Rehabilitation Hospital Nursing. Only selected students may participate that have
Hammond, Louisiana completed prerequisite portion of curriculum. USA CON must
complete Exhibit 1 Pre-Assignment Results Form prior to
student beginning clinicals.
NorthShore Regional Medical Center Exhibits A & B must be signed by student
Slidell, Louisiana
NorthShore Specialty Hospital
Covington, Louisiana
Ochsner Clinic Foundation Exhibits A & B must be signed by student, a drug screen from a
SAMSA approved laboratory within one week of starting
New Orleans, Louisiana clinicals, a criminal background check, a PPD within the last 6
months, copy of current BLS card, and proof of positive titers for
Includes all 32 regional clinics (Slidell, measles, mumps, rubella, and varicella
Covington, etc.)
Ochsner Medical Center Exhibits A & B will need student signatures
Kenner, Louisiana
UNIVERSITY OF SOUTH ALABAMA
COLLEGE OF NURSING
December 13, 2011
Clinical Agency Affiliations and Locations
Ochsner Medical Center, as part of Ochsner Contract includes DNP Students.
Students must complete Exhibit A & B prior to starting clinicals
Clinic Foundation West Bank, LLC (see course coordinator)
Includes: East Baton Rouge Medical Ctr.
New Orleans, Louisiana
Ochsner St. Anne General Hospital Students must complete Exhibit A (Statement of Responsibility)
& Exhibit B (Confidentiality Statement) prior to beginning
New Orleans, Louisiana clinicals.
Our Lady of the Lake Ascension Community
Hospital, Inc. d/b/a St. Elizabeth Hospital Students must complete Attachment 1 (Student Agreement),
Attachment 2 (Confidentiality Agreement), and Attachment 3
Gonzales, Louisiana (Statement of Responsibility) prior to beginning clinicals.
Our Lady of the Lake Ascension Community Students must complete Attachment 1 (Student Agreement),
Attachment 2 (Confidentiality Agreement), and Attachment 3
Hospital, Inc. d/b/a St. Elizabeth Physicians, (Statement of Responsibility) prior to beginning clinicals.
Inc.
Gonzales, Louisiana
Our Lady of the Lake Regional Medical Center Prior to contacting agency, students must have a
background check, TB skin test, and a CURRENT (within 1
Baton Rouge, Louisiana semester) drug screen, and complete Attachments 1-3. If
using a non-OLOL employed physician or third level, the
Revised Sponsoring Physician Letter must be signed prior
to meeting with Dr. Steele-Moses. Students/faculty should
contact Dr. Susan Steele-Moses, Program Director for Nursing
Research prior to beginning clinicals to ensure compliance with
all requirements. Agency must receive electronic clinical
objectives. Program Director must receive specific dates
student will be in this facility. Agency will visually check RN
licensure and current CPR prior to student beginning at this
facility.
Our Lady of Lourdes Regional Medical Center
Lafayette, Louisiana
Regional Medical Center of Acadiana Students must sign Exhibits A and B prior to beginning clinicals.
Lafayette, Louisiana
Slidell Memorial Hospital & Medical Center,
Slidell, Louisiana
St. Francis Medical Center, Inc.
Monroe, Louisiana
St. Tammany Parish Hospital
Covington, Louisiana
Thibodaux Regional Medical Center
Thibodaux, Louisiana
Touro Infirmary Faculty must complete Exhibit A. Student must complete Exhibit
B prior to clinicals.
New Orleans, Louisiana
Tulane University Medical Group (Department
of Pediatrics)
New Orleans, Louisiana
VA Medical Center of Alexandria, LA Gerontological/Adult Psychiatric NP (On-Line) Bachelor and
Master
Alexandria, Louisiana
VA Medical Center of New Orleans Master of Science
New Orleans, Louisiana
VA Medical Center of Overton Brooks Undergraduate & Graduate degrees in Science of Nursing
UNIVERSITY OF SOUTH ALABAMA
COLLEGE OF NURSING
December 13, 2011
Clinical Agency Affiliations and Locations
Shreveport, Louisiana TQCVL Paperwork in file.
Women’s and Children’s Hospital Agency requires a company 10 panel drug screen. Students
must also complete Exhibits A & B prior to beginning clinical
Lafayette, Louisiana rotation.
Maine
Agency Name Agency Requirements
Eastern Maine Medical Center
Bangor, Maine
Maryland
Agency Name Agency Requirements
Mercy Health Services
Baltimore, Maryland
NIH Clinical Center
Bethesda, Maryland
University of Maryland Medical Center Student must complete Attachment A prior to beginning clinicals.
Baltimore, Maryland
Massachusetts
Agency Name Agency Requirements
Massachusetts General Hospital (General Students must complete Confidentiality Agreement prior to
beginning clinicals. Students must also review the following:
Hospital Corp) “Physical Removal & Transport of Protected Health Information
Boston, Massachusetts & Personal Information,” “Laptop Encryption Policy,” & “Portable
USB Drive Encryption” in addition to completing the
HEALTHSTREAM training module.
VA Medical Center of Northhampton, MA Graduate Degree
Leeds, MA
Michigan
Agency Name Agency Requirements
UNIVERSITY OF SOUTH ALABAMA
COLLEGE OF NURSING
December 13, 2011
Clinical Agency Affiliations and Locations
Munson Medical Center
Transverse City, Michigan
Oakwood Healthcare, Inc.
Dearborn, Michigan
Saint Mary’s of Michigan Standish Hospital
Saginaw, Michigan
University of Michigan Health System
Ann Arbor, Michigan
VA Medical Center of Ann Arbor Nursing Program, Master’s
Ann Arbor, Michigan
Minnesota
Agency Name Agency Requirements
Allina Health System Agency requires grading faculty to have a current Minnesota
license. Faculty must complete roster and associated
Minneapolis, Minnesota documentation at least one month prior to clinical experience.
Children’s Healthcare d/b/a Children’s
Hospitals & Clinics of Minnesota
Minneapolis, Minnesota
Fairview Health Services DNP students only
Minneapolis, Minnesota
Hennepin County Medical Center Students must cooperate with HCMC in obtaining a Minnesota
Background study before beginning clinicals.
Minneapolis, Minnesota
North Memorial Health Care Minnesota RN license required for Faculty.
Robbinsdale, Minnesota
St. Cloud VA Medical Center
St. Cloud, Minnesota
University of Minnesota Physicians
Minneapolis, Minnesota
Mississippi
Agency Name Agency Requirements
Baptist Memorial Hospital – Golden Triangle
Columbus, Mississippi
Biloxi Regional Medical Center Following is required prior to clinicals by Mississippi Department
of Health: Background check state of MS. (addl Fee), MMR,
Biloxi, Mississippi PPD-must be within 1 year of expected date of completion of
clinical rotation
Coastal Family Health Center
Biloxi, Mississippi
UNIVERSITY OF SOUTH ALABAMA
COLLEGE OF NURSING
December 13, 2011
Clinical Agency Affiliations and Locations
Delta Regional Medical Center
Greenville, Mississippi
George Regional Health Systems
Lucedale, Mississippi
Gulf Coast Mental Health Center
Gulfport, Mississippi
Gulfport School District
Gulfport, Mississippi
Jeff Anderson Regional Medical Center
Meridian, Mississippi
Keesler Medical Center, 81st Medical Group, Master of Science in Nursing
Keesler AFB, Mississippi
Memorial Hospital at Gulfport (Indoor and Outdoor) Tobacco free environment
Fingerprinting is required. Student pays $50 fee to hospital.
Gulfport, Mississippi
Mississippi Baptist Health Systems, Inc.,
Mississippi Baptist Medical Center, Inc., and
Mississippi Hospital for Restorative Care, Inc.
Jackson, Mississippi
Mississippi State Department of Health
Jackson, Mississippi
North Mississippi Health System BSN and MSN Students—Attachments required prior to
clinicals. Faculty, please see me regarding attachments.
Tupelo, Mississippi
North Mississippi State Hospital
Tupelo, Mississippi
River Oaks Hospital
Jackson, Mississippi
River Oaks Woman’s Hospital
Jackson, Mississippi
Rush Foundation Hospital (Rush Health
Systems)
Meridian, Mississippi
Select Specialty Hospital
Gulfport, Mississippi
Singing River Hospital System, (Includes
Singing River and Ocean Springs Hospitals)
Pascagoula, Mississippi
South Central Regional Medical Center RN to BSN, graduate students
Grad students please see Ms. Beth Endom
Laurel, Mississippi prior to starting
South Mississippi Home Health, Inc.
Hattiesburg, Mississippi
Southwest Mississippi Regional Medical
Center
McComb, Mississippi
The Diabetes Center
UNIVERSITY OF SOUTH ALABAMA
COLLEGE OF NURSING
December 13, 2011
Clinical Agency Affiliations and Locations
Ocean Springs, Mississippi
University of Mississippi Medical Center
Jackson, Mississippi
Veterans Affairs Gulf Coast Healthcare Nursing: BSN, MSN, and graduate students
Agency requires Trainee Qualifications and Credentials
System Verification Letter (TQCVL) signed by Program Director.
Biloxi, Mississippi
VA Medical Center - G.V. (Sonny) Occupational Therapy – MS
Nursing – Acute NP (Masters)
Montgomery Nursing – Geri Psych NP (Masters)
Jackson, Mississippi Nursing – Family NP (Masters)
Nursing – BSN
Nursing – MSN
Masters-ENP Program
Clinical Nurse Leader (MSN)
Vicksburg Healthcare, LLC d/b/a River Region Students must submit to substance abuse testing every 12
months (to test for presence of alcohol, drugs, or other
Health System controlled substances).
Vicksburg, Mississippi
Wesley Medical Center “Student Agreement Only”-Students should complete a Term
Sheet from the agency Now includes FNP students
Hattiesburg, MS
Missouri
Agency Name Agency Requirements
Children’s Mercy Hospital and Clinics
Kansas City, Missouri
Family Health Care Center Faculty, any correspondence with preceptors must be copied to
Mr. Dennis Kruse, CFO-401 Holly Hills Avenue, St. Louis, MO
Saint Louis, Missouri 63111-2410
ReHab Care
Austin, TX or St. Louis, MO
Heartland Regional Medical Center Student must complete a Missouri Background check,
recommendations can be found at www.heartland-
St. Joseph, Missouri health.com/students. Students and Faculty are not allowed to
enter airborne isolation areas.
St. Louis Children’s Hospital Faculty, please request a copy of the “additional terms” form
prior to students beginning clinicals
St. Louis, Missouri
VA Medical Center of St. Louis, MO
St. Louis, Missouri
Nebraska
Agency Name Agency Requirements
UNIVERSITY OF SOUTH ALABAMA
COLLEGE OF NURSING
December 13, 2011
Clinical Agency Affiliations and Locations
Creighton University Medical Center Students must complete Exhibits A & B in addition to viewing
video prior to the state date of clinical rotation. Faculty contact
Omaha, Nebraska contract office for video and to complete Exhibit C.
Nebraska Methodist Hospital
Omaha, Nebraska
Nevada
Agency Name Agency Requirements
99th Medical Group, Mike O’Callaghan Federal Student must complete Trainee Agreement Addendum
Hospital
Nellis Air Force Base, Nevada
Carson Tahoe Regional Healthcare
Carson City, Nevada
New Hampshire
Agency Name Agency Requirements
Catholic Medical Center
Manchester, New Hampshire
Elliot Health System
Manchester, New Hampshire
Littleton Regional Hospital
Littleton, New Hampshire
Mary Hitchcock Memorial Hospital, Nurse Practitioner Agreement – student must hold an RN
license to practice in the State of New Hampshire
Dartmouth-Hitchcock Clinic
Lebanon, New Hampshire
Wentworth-Douglass Hospital Student must provide agency a copy of the following: 5-Panel
Drug/Alcohol Screen, Background Check, Proof of Physical
Dover, New Hampshire within 1 year including TB, & Record of Immunizations
New Jersey
Agency Name Agency Requirements
AtlantiCare Regional Medical Center
Egg Harbor Township, New Jersey
Cooper University Hospital Attachments to be completed by faculty and student
UNIVERSITY OF SOUTH ALABAMA
COLLEGE OF NURSING
December 13, 2011
Clinical Agency Affiliations and Locations
Camden, New Jersey
South Jersey Hospital, Inc. (aka Bridgeton
Mental Health Unit)
Bridgeton, New Jersey
New Mexico
Agency Name Agency Requirements
27th Special Operations Medical Group Student must sign Attachment 1 – Trainee Agreement
Addendum prior to beginning clinicals.
Cannon Air Force Base, New Mexico
Presbyterian Healthcare Services Student must sign and complete Exhibit B prior to beginning
clinicals.
Albuquerque, New Mexico
Public Health Division of the New Mexico
Department of Health
Santa Fe, New Mexico
University of New Mexico Hospital Agency requires student(s) be complete drug screening within 6
months before beginning clinicals at UNMH. Faculty to complete
Albuquerque, New Mexico Exhibit A. Student(s) must provide UNMH and USA CON with
copy of certificate of insurance as proof of their property damage
coverage.
VA Medical Center of New Mexico BSN and MSN
Albuquerque, New Mexico
North Carolina
Agency Name Agency Requirements
Brynn Marr Behavioral Healthcare System
Jacksonville, North Carolina
CaroMont Health
Gastonia, North Carolina
Charlotte Mecklenburg Hospital Authority
d/b/a Carolinas HealthCare System
Charlotte, North Carolina
Cumberland County Hospital System, Inc. Students must complete Appendix 1 prior to beginning clinicals.
Faculty, please contact CON contract office for appendix.
d/b/a Cape Fear Valley Health System
Fayetteville, North Carolina
Duke University Health System, Inc. Student will not be permitted on-site without documentation verifying
Criminal Background Check and Immunization status & signed
Durham, North Carolina Confidentiality Statement on file. Student will need to complete
Compliance and Safety Training and have current CPR certificate.
Faculty should contact Contract person at CON regarding student’s
paperwork.
Gaston Health Care, Inc. d/b/a CaroMont Only for Acute Care Nurse Practitioner students.
Health
UNIVERSITY OF SOUTH ALABAMA
COLLEGE OF NURSING
December 13, 2011
Clinical Agency Affiliations and Locations
Gastonia, North Carolina
MedWest Healthcare System to include: Students must review the online Academic Affiliate Clinical Rotation
Manual and complete required documents 4 weeks in advance of the
MedWest Haywood, MedWest Harris, and start of the clinical experience. (Appendices A-E must be completed).
Medwest Swain www.medwesthealth.org/academic_affiliate_orientation_manual.aspx
Faculty: please email contracts department for attachment.
Clyde, North Carolina
Moses Cone Health System A negative Twelve Panel Urine Drug Screen report test from a
National Institute of Drug Abuse (NIDA) approved laboratory on file
Greensboro, North Carolina prior to the first assignment/student experience at MCHS with USA
CON.
Naval Health Clinic
Cherry Point, North Carolina
Novant Health Hospitals Students please request Attachment C (from faculty)prior to starting
clinicals
North Carolina
Triad Region: Forsyth Memorial Hospital,
Foundation Health Systems, Carolina Medicorp
Enterprises, Forsyth Medical Group,
Community General Health Partners, Medical
Park Hospital.
Southern Piedmont Region: Presbyterian
Orthopaedic Hospital, Presbyterian Medical
Matthews, Presbyterian Hospital, Presbyterian
Regional Healthcare, Presbyterian Hospital
Huntersville
Orange County Health Department
Hillsborough, North Carolina
W.G. (Bill) Hefner VA Medical Center Faculty must complete the “Clinical Education Form and Clinical
Instructor Form ” prior to the student beginning clinicals
Salisbury, NC
VA Medical Center of Asheville, NC Advanced Practice Nursing
Asheville, North Carolina
VA Medical Center of Fayetteville Family Psychiatric NP students only
Fayetteville, North Carolina
Wake Forest University Baptist Medical For Clinical Faculty and Students additional on-site
requirements may include participating in orientation, on site
Center (North Carolina Baptist Hospital) HIPAA and other training, submission to a TB test, submission
of a criminal background check, a 10 panel drug screen, and
Winston-Salem, North Carolina proof of a seasonal flu vaccine.
Womack Army Medical Center For MSN students only – No more than two (2) trainees annually
Ft. Bragg, North Carolina
North Dakota
UNIVERSITY OF SOUTH ALABAMA
COLLEGE OF NURSING
December 13, 2011
Clinical Agency Affiliations and Locations
Agency Name Agency Requirements
Medcenter One, Inc. Preventive health requirement form has to be completed on
student. Student must complete Net Learning System. Faculty
Bismarck, North Dakota should contact Contract person at CON.
Ohio
Agency Name Agency Requirements
Ohio State University Medical Center Students please request information about Ohio Board of
Nursing Requirements(Attachment A)
Columbus, Ohio
Ohio State University- on behalf of The Arthur Faculty members please see me regarding attachment A prior to
student’s clinical experience
James Cancer Hospital and Richard J. Solove
Research Institute
Columbus, Ohio
Summa Health System Hospitals
Akron, Ohio
The Toledo Hospital
Toledo, Ohio
VA Medical Center of Dayton, OH Master in Nursing
Dayton, Ohio
Oklahoma
Agency Name Agency Requirements
AHS Oklahoma Health System, LLP
Tulsa, Oklahoma
Alegent Health
Omaha, Nebraska
INTEGRIS Health, Inc. Students must complete Exhibit A, Student Confidentiality
Agreement
Oklahoma City, Oklahoma
Oklahoma City Indian Clinic Students must provide agency with a copy of their current
criminal record check and shot records to include: proof of TB
Oklahoma City, Oklahoma skin test (within 1 year), proof of rubella/rubeola, proof of
chickenpox (either immunization, titer, or signed statement of
past infection, and proof of Hep B immunization or declination
form.
Oklahoma State Department of Health Students must complete HIPAA Training for Nursing Students at
https://ok.train.org/desktopshell.aspx. Please see clinical faculty
Oklahoma City, Oklahoma for detailed instructions.
OU Medical Center Students are required to submit flu vaccinations information and
additional paperwork prior to clinicals to Steven Gifford via fax to
Oklahoma City, Oklahoma
(405) 271-7344. Students must review the orientation
information online prior to beginning clinicals. (see website
below) Faculty should contact Contract person at CON with any
questions. Students must adhere to agency’s Flu Vaccine
UNIVERSITY OF SOUTH ALABAMA
COLLEGE OF NURSING
December 13, 2011
Clinical Agency Affiliations and Locations
program –see attachment.
http://www.oumedicine.com/body.cfm?id=832
Please see Vonda Epperly at site for further orientation
information prior to starting clinicals.
OU Physicians Student must complete Attachment A, “Affiliation Confidentiality
Agreement,” prior to beginning clinicals.
Oklahoma City, Oklahoma
Planned Parenthood of Arkansas and Eastern Arkansas Board of Nursing must be notified by faculty of
student name, licenses number, preceptor information, clinical
Oklahoma, Inc. site, course of enrollment and number of clinical hours.
Tulsa, Oklahoma
St. Francis Health System, Inc. Graduate advisor to confirm background check w/ agency and
faculty to contact agency prior to students beginning clinicals.
Tulsa, Oklahoma
Tinker Air Force Base(72nd Medical Group) FNP students in the pediatric population utilizing the Pediatric
Clinic.
Oklahoma City, Oklahoma
VA Medical Center–South Central OK Master of Science, Nurse Practitioner (MS)
Oklahoma City, Oklahoma
Oregon
Agency Name Agency Requirements
PeaceHealth Oregon Region (Springfield,
Eugene, Creswell and Cottage Grove,
Oregon)
Providence Health and Services Background check must be dated less than two years prior to
practicum. Any adverse results must be shared with the
(Oregon Region) hospital. Background check verification letter required. HIPAA
Portland, Oregon – DVD and brochure reviews required.
VA Healthcare System of Roseburg MSN, Post-Masters Advanced Psychiatric-Mental Health
(NP/CNS) programs
Roseburg, Oregon
VA Medical Center of Portland, OR Gerontological/Adult Psychiatric, Masters
Portland, Oregon
South Carolina
Agency Name Agency Requirements
Aiken Regional Medical Centers Affiliation agreement only covers Nurse Practitioner students
Aiken, South Carolina
Columbia Area Mental Health Center
Columbia, South Carolina
UNIVERSITY OF SOUTH ALABAMA
COLLEGE OF NURSING
December 13, 2011
Clinical Agency Affiliations and Locations
Eau Claire Cooperative Health Centers, Inc.
(Includes Waverly Family Practice)
Columbia, South Carolina
Greenville Hospital University Medical Center Students must complete Verification Form, Appendix C, and
Appendix D prior to clinicals. All rotations must be approved
Greenville, South Carolina through “Students Services Dept.” 4 months prior to start date.
Medical University Hospital Authority
Medical University of South Carolina
Charleston, South Carolina
Moncrief Army Community Hospital Family Psychiatric Nurse Practitioner students.
Fort Jackson, SC
Sisters of Charity Providence Hospital Students should contact Ms. Soderstrom at agency for
additional paperwork requirements prior to clinicals.
Columbia, South Carolina
South Carolina Dept. Health and Environment
Control
Columbia, South Carolina
South Carolina Department of Mental Health
(Division of Inpatient Services)
Columbia, South Carolina
University of South Carolina
Columbia, South Carolina
South Dakota
Agency Name Agency Requirements
Sanford Health Students must review and complete the Sanford Health
Orientation Packet. Faculty must complete the Faculty
Sioux Falls, South Dakota Verification form and provide objectives and the final preceptor
evaluation form no later than 2 weeks before clinical experience
begins.
Tennessee
Agency Name Agency Requirements
Chattanooga-Hamilton County Hospital
Authority d/b/a Erlanger Health System
Chattanooga, Tennessee
Covenant Health Completion of Exhibits A & B prior to student beginning clinicals
Knoxville, Tennessee
Dyersburg Regional Medical Center
Dyersburg, Tennessee
HCA Health Services of Tennessee, d/b/a
Centennial Medical Center
Nashville, Tennessee
Jackson-Madison County General Hospital,
UNIVERSITY OF SOUTH ALABAMA
COLLEGE OF NURSING
December 13, 2011
Clinical Agency Affiliations and Locations
West TN Healthcare
Jackson, Tennessee
Matthew Walker Comprehensive Health
Center
Nashville, Tennessee
Maury Regional Hospital d/b/a Maury Regional
Medical Center
Columbia, Tennessee
Mercy Health System, Inc. (formerly St. Mary’s Student must have 30 day advance approval from agency.
Health System)
Knoxville, Tennessee
Methodist Healthcare-Memphis Hospitals Students: Exhibit A must be completed prior to starting clinicals.
Please see course coordinator regarding details.
Memphis, Tennessee Students must complete a ten-panel drug screen from an
independent provider within 30 days of the commencement date
of the clinical experience as well as a criminal background check
conducted within the preceding 12 months prior to clinical
training.
St. Francis Hospital Students must complete Exhibits A, B, & C prior to beginning
clinicals.
Memphis, Tennessee
St. Mary’s Health System (now owned by Mercy Student must have 30 day advance approval from agency.
Health System, Inc.)
Knoxville, Tennessee
Southeastern Emergency Physicians, Inc.
Knoxville, Tennessee
The Little Clinic
Brentwood, Tennessee
University Health System, Inc. Student must complete Exhibits A & B prior to beginning
clinicals
Knoxville, Tennessee
Vanderbilt University (Hospital, Clinic, Clinical rotation criteria and background investigation.
Children’s Hospital)
Nashville, Tennessee
Tennessee Valley Healthcare System Master of Science
Nashville, Tennessee
VA Medical Center of Memphis, TN
Memphis, Tennessee
Veterans Affairs Outpatient Clinic Graduate Program,
Master of Science in Nursing
Chattanooga, Tennessee
Texas
Agency Name Agency Requirements
Baptist Health System *Student must complete Exhibit A & B before starting clinicals.
(See Faculty for information)
San Antonio, Texas *Students are required to have flu and HINI vaccines by
UNIVERSITY OF SOUTH ALABAMA
COLLEGE OF NURSING
December 13, 2011
Clinical Agency Affiliations and Locations
December 15, 2009 and the Proof of Vaccination form must be
completed prior to clinicals. (See faculty member regarding
form).
Carl R. Darnall Army Medical Center
Fort Hood, Texas
Children’s Medical Center of Dallas Master’s Degree in Nursing
Dallas, Texas
Dallas County Hospital District d/b/a Parkland Nurse Practitioner students only
Health & Hospital System
Dallas, Texas
Darnall Army Community Hospital Program leads to Masters of Science in Nursing in
Community/Public Health Nursing
Fort Hood, Texas
Driscoll Children’s Hospital Students must complete Exhibits A & B prior to beginning
clinicals. CON must complete Exhibit C on behalf of student.
Corpus Christi, Texas Effective Flu Season 2011, the Influenza Vaccine is
MANDATORY for all program participants (instructors and
students). Exhibit C must be completed prior to beginning
clinicals.
El Paso County Hospital District, d/b/a R.E. Students must complete agency’s Non-Disclosure Agreement
and attend orientation provided by the hospital prior to beginning
Thomason General Hospital clinicals.
El Paso, Texas
HCA North Texas (includes Denton Regional Medical Students must complete Exhibit A (Statement of Responsibility)
and Exhibit B (Confidentiality Statement) prior to beginning
Center, Green Oaks Psychiatric Hospital, Las Colinas
clinical rotation.
Medical Center, Medical Center of Arlington, Medical
Center of Lewisville, Medical Center of McKinney,
Medical Center of Plano, Medical City Dallas Hospital,
North Hills Hospital, and/or Plaza Medical Center of Fort
Worth)
Irving, Texas
Memorial Hermann Northwest Hospital Students must complete Exhibit B prior to beginning clinicals.
Houston, Texas
Memorial Hermann-Texas Medical Center and Students please see Mary Margaret Evans@ site for required
paperwork prior to clinicals. Also Student Faculty requirements
Children’s Memorial Hermann Hospital in file.
Houston, Texas
Memorial Hermann The Woodlands Hospital Students must complete Exhibit B prior to beginning clinicals.
The Woodlands, Texas
Methodist Healthcare System of San Antonio, Non-MHS employees must go to MHS HIPAA and ethics
session prior to beginning clinicals.
Ltd., L.L.P. *Employment verification required (for 7 years)
San Antonio, Texas
Northwest Texas Healthcare System
Amarillo, Texas
Planned Parenthood of Houston and
Southeast Texas, Inc.
Houston, Texas
Presbyterian Hospital of Plano Course Coordinators-please complete attachments
Plano, Texas
R.E. Thomason General Hospital (El Paso Students must complete agency’s Non-Disclosure Agreement
and attend orientation provided by the hospital prior to beginning
County Hospital District) clinicals.
El Paso, Texas
UNIVERSITY OF SOUTH ALABAMA
COLLEGE OF NURSING
December 13, 2011
Clinical Agency Affiliations and Locations
ReHab Care
Austin, TX or St. Louis, MO
TCH Pediatric Associates, Inc. d/b/a Texas
Children’s Pediatric Associates
Houston, Texas
Texas Tech University Health Sciences Faculty must complete Faculty of Record/Coordinator
Credentialing form and Pre-Clinical Clearance Form prior to
Center, Paul L. Foster School of Medicine, students beginning clinicals. Faculty please contact Alicia
Department of Pediatrics Gacharna at (915) 545-6921 for forms.
El Paso, Texas
The University of Texas Medical Branch at Correctional Managed Care department and Ob-Gyn
Department (Regional Maternal & Child Health Programs)
Galveston
Galveston, Texas
University Medical Center of El Paso (formerly Students please see agency contract specialist regarding
special instructions/attachments required before clinicals
R.E. Thomason General Hospital)
El Paso, Texas
VA Medical Center of Michael DeBakey
Center
Houston, Texas
Veterans Affairs North Texas Medical Center Advanced Geropsych Assessment Older Adults Practicum RN-
BSN-MSN
Dallas, Texas Master of Science in Nursing
William Beaumont Army Medical Center Family Nurse Practitioner students
(Agreement applies to only one trainee at a time).
El Paso, Texas
Utah
Agency Name Agency Requirements
Brigham City Community Hospital Students must complete Exhibit A and B. Faculty must complete
Exhibit C on behalf of the student.
Brigham City, Utah
Central Utah Clinic
Provo, Utah
IHC Health Services, Inc. (Intermountain
Healthcare)
Salt Lake City, Utah
Vermont
Agency Name Agency Requirements
Fletcher Allen Health Care
Burlington, Vermont
UNIVERSITY OF SOUTH ALABAMA
COLLEGE OF NURSING
December 13, 2011
Clinical Agency Affiliations and Locations
Virginia
Agency Name Agency Requirements
Chesapeake Hospital Authority d/b/a
Chesapeake Regional Medical Center
Chesapeake, Virginia
Kenner Army Health Clinic (includes Wilkerson
Pediatric Clinic)
Fort Lee, Virginia
Medicorp Health System (includes Mary
Washington Healthcare)
Fredericksburg, Virginia
Naval Medical Center Nurse Practitioner students and Clinical Nurse educator
students—See faculty first
Portsmouth, Virginia ***Faculty must contact the agency and complete the
agency’s request form prior to students starting clinicals.
Students please see agency official regarding Parking
regulations.
Prince William Health District (Virginia
Department of Health)
Woodbridge, Virginia
Sentara Healthcare System (includes: Sentara Students must purchase additional professional liability
insurance (outside of USA) with limits of $1 million/occurrence
Bayside Hospital, Sentara Leigh Hospital, and $3 million aggregate in order to intern at this site, since
Sentara Norfolk General Hospital, Sentara Virginia law requires higher limits that the University offers.
Careplex Hospital, Sentara Virginia Beach
General Hospital, Sentara Williamsburg
Regional Medical Center, & Sentara Louise
Obici Memorial Hospital)
Chesapeake, Virginia
University of Virginia Health System Nurse Practitioner Agreement
Charlottesville, Virginia
Valley Health System Agency requires a 10-panel drug screen; student must maintain
professional liability insurance in the amounts of $2
Winchester, Virginia million/occurrence and $6 million aggregate; student must
complete exhibits prior to beginning clinicals.
Virginia Commonwealth University Health
System (Medical College of Virginia)
Richmond, Virginia
Washington
Agency Name Agency Requirements
DSHS Mental Health Division (Western State
Hospital)
UNIVERSITY OF SOUTH ALABAMA
COLLEGE OF NURSING
December 13, 2011
Clinical Agency Affiliations and Locations
Olympia, Washington
Shriners Hospitals for Children * Agreement begins effective term August 22, 2011.
Spokane, Washington
VA Puget Sound Health Care System
Seattle, Washington
Western State Hospital—DSHS Mental Health
Division
Olympia, Washington
Washington D.C
Agency Name Agency Requirements
Children’s Hospital
Washington, D.C.
Georgetown University Hospital The following items must be completed prior to student
beginning clinicals: Faculty provides syllabus to CON contract
Washington, D.C. office as Attachment A, Dean must sign Attachment B, and
student signs Attachment D.
West Virginia
Agency Name Agency Requirements
VA Medical Center of Huntington
Huntington, West Virginia
Wisconsin
Agency Name Agency Requirements
Affinity Health System Students must complete Exhibit B and review Exhibit C
Menasha, Wisconsin
Aurora Medical Group, Inc.
Milwaukee, Wisconsin
Bellin Memorial Hospital, Inc. Students must complete agency’s application, Wisconsin
Background Information Disclosure form, return agency’s HIPAA
Green Bay, Wisconsin confidentiality agreement, self-study orientation packet and test
must be completed prior to start of rotation. Contact is Beth
Markon: (920) 433-7858
UNIVERSITY OF SOUTH ALABAMA
COLLEGE OF NURSING
December 13, 2011
Clinical Agency Affiliations and Locations
Gundersen Lutheran – Internal Medicine
La Crosse, Wisconsin
Mercy Health System
Janesville, Wisconsin
St. Vincent Hospital of the Hospital Sisters of Agency requires letter of good standing and verification of
competency in sterile technique training for each student.
the Third Order of St. Francis and St. Mary’s
Hospital Medical Center of Green Bay, Inc.
Green Bay, Wisconsin
Zablocki VA Medical Center
Milwaukee, Wisconsin
Wyoming
Agency Name Agency Requirements
VA Medical Center of Cheyenne Nursing/Nurse Practitioner/MS
Cheyenne, WY
INTERNATIONAL AGENCIES
Germany
Agency Name Agency Requirements
Landstuhl Regional Medical Center
APO AE
U.S. Medical Department Activity Bavaria, Trainees must have an interest in serving the US military as
either a DA civilian or on active duty. The rotation will expose
U.S. Army Health Clinic Vilseck the applicant to military medicine during the clinical rotation. The
trainee will be asked to speak to an Army medicine recruiter.
This conversation or rotation will not obligate the trainee to any
military medicine service.