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UNIVERSITY OF SOUTH ALABAMA

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					                         UNIVERSITY OF SOUTH ALABAMA
                                COLLEGE OF NURSING
                                   December 13, 2011
                      Clinical Agency Affiliations and Locations
                Agency Name                                    Agency Requirements
 rd                                       Attachment 1 and 2 for Trainee Agreement Addendum
3 Medical Group
Elmendorf AFB, Alaska
15 Place
Mobile, Alabama
27th Special Operations Medical Group Studentbeginning clinicals. 1 – Trainee Agreement Addendum
                                          prior to
                                                    must sign Attachment

Cannon Air Force Base, New Mexico
42nd Medical Group
Maxwell Air Force Base, Alabama
72nd Medical Group                        FNP students in the pediatric population utilizing the Pediatric Clinic.

Tinker AFB, Oklahoma City, OK
99th Medical Group, Mike O’Callaghan      Student must complete Trainee Agreement Addendum

Federal Hospital
Nellis Air Force Base, Nevada
Affinity Health System                    Students must complete Exhibit B and review Exhibit C

Menasha, Wisconsin
AHS Oklahoma Health System, LLP
Tulsa, Oklahoma
Aiken Regional Medical Centers            Affiliation agreement only covers Nurse Practitioner students

Aiken, South Carolina
Alabama Department of Public Health,
(Alabama inclusive)
Alabama Department of Rehabilitation
Services
Mobile, AL
Alegent Health
Omaha, Nebraska
Allen Memorial Home
Mobile, Alabama
Allina Health System                      Agency requires grading faculty to have a current Minnesota license.
                                          Faculty must complete roster and associated documentation at least
Minneapolis, Minnesota                    one month prior to clinical experience.
AltaPointe Health Systems, Inc. (formerly
Mobile Mental Health)
Mobile, Alabama
Appling Health Care System
St. Baxley, Georgia
Arkansas Children’s Hospital
Little Rock, Arkansas
Arkansas Department of Health &                       Students attachments 1 & 2 must be completed prior to starting
                                                      clinicals. See course coordinator.
Human 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.
AtlantiCare Regional Medical Center
Egg Harbor Township, New Jersey
Aurora Medical Group, Inc.
                        UNIVERSITY OF SOUTH ALABAMA
                               COLLEGE OF NURSING
                                 December 13, 2011
                     Clinical Agency Affiliations and Locations
               Agency Name                                  Agency Requirements
Milwaukee, Wisconsin
Baker County Health Department
Macclenny, Florida
Baldwin County Mental Health
Fairhope, Alabama
Baldwin County Public Schools           Faculty must notify school prior to clinical experience

Fairhope, Alabama
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
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 December
                                                     15, 2009 and the Proof of Vaccination form must be completed prior
                                                     to clinicals. (See faculty member regarding form).
Baptist Healthcare System, Inc. d/b/a                Student must sign Statement of Understanding and Confidentiality
                                                     Agreement.
Central Baptist Hospital
Lexington, Kentucky
Baptist Medical Center South (includes               Students must complete required training before beginning training
                                                     and sign an individual agreement with agency.
Baptist Medical Center East and Prattville
Baptist Hospital)
Montgomery, Alabama
Baptist Memorial Hospital – Golden
Triangle
Columbus, Mississippi
Baton Rouge General Medical Center                   Physical Therapy, Occupational Therapy and Nursing Students
                                                     contract
Baton Rouge, Louisiana
Bay County Health Department
Panama City, Florida

Bay Medical Center
Panama City, Florida
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
Beverly Healthcare
Foley, Alabama
Biloxi Regional Medical Center                       Following is required prior to clinicals by Mississippi Department of
                                                     Health: Background check state of MS. (addl Fee), MMR, PPD-must
Biloxi, Mississippi                                  be within 1 year of expected date of completion of clinical rotation
Blanchfield Army Community Hospital
Fort Campbell, Kentucky
BMA of Alabama (Dialysis Outpatient
Clinic)
                      UNIVERSITY OF SOUTH ALABAMA
                             COLLEGE OF NURSING
                               December 13, 2011
                   Clinical Agency Affiliations and Locations
              Agency Name                          Agency Requirements
Mobile, Alabama
Boise VAMC
Boise, Idaho
Brigham City Community Hospital          Students must complete Exhibit A and B. Faculty must fill our Exhibit
                                         C on behalf of the student.
Brigham City, Utah
Brookwood Health Services, Inc.          BSN students: Request Attachments A-C prior to clinical. They are
                                         Statement of Responsibility, Confidentially Statement, Background
Birmingham, Alabama                      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.
Brynn Marr Behavioral Healthcare
System Jacksonville, North Carolina
Camp Grace, Inc.
Mobile, Alabama
Carl R. Darnall Army Medical Center
Fort Hood, Texas
CaroMont Health
Gastonia, North Carolina
Carson Tahoe Regional Healthcare
Carson City, Nevada
Cathedral Place Apartments
Mobile, Alabama
Catholic Medical Center
Manchester, New Hampshire
Central Arkansas Veterans Healthcare     BSN Degree, RN-BSN, RN-MSN
                                         Arkansas Board of Nursing must be notified by faculty of student
System                                   name, licenses number, preceptor information, clinical site, course of
Little Rock, Arkansas                    enrollment and number of clinical hours.

Central Plaza Towers
Mobile, Alabama
Central Utah Clinic
Provo, Utah
Centura Hospitals in Colorado
Englewood, Colorado
Charlotte Mecklenburg Hospital
Authority d/b/a Carolinas HealthCare
System
Charlotte, North Carolina
Chattanooga-Hamilton County Hospital
Authority d/b/a Erlanger Health System
Chattanooga, Tennessee
Chesapeake Hospital Authority d/b/a
                          UNIVERSITY OF SOUTH ALABAMA
                                 COLLEGE OF NURSING
                                   December 13, 2011
                       Clinical Agency Affiliations and Locations
                Agency Name                                     Agency Requirements
Chesapeake Regional Medical Center
Chesapeake, Virginia
Children’s Healthcare d/b/a Children’s
Hospitals & Clinics of Minnesota
Minneapolis, Minnesota
Children’s Healthcare of Atlanta          Students must complete Exhibits A, B-1, and C prior to clinical.

Atlanta, Georgia
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.
Children’s Hospital
New Orleans, Louisiana
Children’s Hospital
Washington, D.C.
Children’s Medical Center of Dallas       Master’s Degree in Nursing

Dallas, Texas
Children’s Med Services, Florida
Department of Health
Panama City, Florida
Children’s Mercy Hospital and Clinics
Kansas City, Missouri
Children’s Rehab Services
Mobile, Alabama
Christus Health Northern Louisiana
Shreveport, Louisiana
Citrus County Health Department
Lecanto, Florida
Coastal Family Health Center
Biloxi, Mississippi
Coastal Hospice Care, Inc.
Saraland, Alabama
Columbia Area Mental Health Center
Columbia, South Carolina
Community Action Agency Head Start
of Baldwin County
Daphne, Alabama
Cooper University Hospital                Attachments to be completed by faculty and student

Camden, New Jersey
Covenant Health                           Completion of Exhibits A & B prior to student beginning clinicals

Knoxville, Tennessee
Covenant Hospice
Daphne, Alabama
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 contract
Omaha, Nebraska                           office for video and to complete Exhibit C.
                          UNIVERSITY OF SOUTH ALABAMA
                                COLLEGE OF NURSING
                                   December 13, 2011
                      Clinical Agency Affiliations and Locations
                Agency Name                                   Agency Requirements
Cumberland County Hospital System,       Students must complete Appendix 1 prior to beginning clinicals.
                                         Faculty, please contact CON contract office for appendix.
Inc. d/b/a Cape Fear Valley Health
System
Fayetteville, North Carolina
DCH Regional Medical Center
Tuscaloosa, Alabama
DSHS Mental Health Division (Western
State Hospital)
Olympia, Washington
Dallas County Hospital District d/b/a    Nurse Practitioner students only

Parkland 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
Dauterive Hospital
New Iberia, Louisiana
Dekalb Medical Center                    Nurse Practitioner Agreement

Decatur, Georgia
Delta Regional Medical Center
Greenville, Mississippi
Doctors Hospital of Augusta              Students must complete Exhibit B as well as the Statement of
                                         Responsibility prior to starting clinicals (see faculty)
Augusta, Georgia
Driscoll Children’s Hospital             Students must complete Exhibits A & B prior to beginning clinicals.
                                         CON must complete Exhibit C on behalf of student. Effective Flu
Corpus Christi, Texas                    Season 2011, the Influenza Vaccine is MANDATORY for all
                                                   program participants (instructors and students). Exhibit C must be
                                                   completed prior to beginning clinicals.
Duke University Affiliated Physicians,             Student will not be permitted on-site without documentation verifying
                                                   Criminal Background Check and Immunization status & signed
Inc.                                               Confidentiality Statement on file. Student will need to complete
Durham, North Carolina                             Compliance and Safety Training and have current CPR certificate.
                                                   Faculty should contact Contract person at CON regarding student’s
                                                   paperwork.
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.
Dumas Wesley Community Center
Mobile, Alabama
Dwight David Eisenhower Army
Medical Center
Fort Gordon, Georgia
Dyersburg Regional Medical Center
Dyersburg, Tennessee
East Alabama Medical Center
Opelika, Alabama
Eastern Idaho Health Services
                        UNIVERSITY OF SOUTH ALABAMA
                              COLLEGE OF NURSING
                                December 13, 2011
                    Clinical Agency Affiliations and Locations
               Agency Name                                 Agency Requirements
Idaho Falls, Idaho
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.
Eastern Maine Medical Center
Bangor, Maine
Eau Claire Cooperative Health Centers,
Inc. (Includes Waverly Family Practice)
Columbia, South Carolina
Eglin Air Force Base, 96th Medical                Undergraduate and graduate nursing degree programs– Students
                                                  must sign the Trainee Agreement Addendum
Group/SGSF
Eglin AFB, Florida
El Paso County Hospital District, d/b/a           Students must complete agency’s Non-Disclosure Agreement and
                                                  attend orientation provided by the hospital prior to beginning clinicals.
R.E. Thomason General Hospital
El Paso, Texas
Elliot Health System
Manchester, New Hampshire
Emory University Hospital                         Students please request attachments from the course
                                                  coordinator. These documents must be completed prior to
includes:[Emory Crawford Long Hospital,           clinicals.
Wesley Woods Center, Emory University
Orthopedic and Spine Hospital, The Emory
Clinic, Emory Children’s Center]
Atlanta, Georgia
Enterprise Clinic, LLC (d/b/a Hartford            Students must complete Addendum 1 & 2. Nurse Practitioner
                                                  must complete Addendum 3, 4 and 5.
Family Medicine)
Hartford, Alabama
Escambia County Health Department
Pensacola, Florida
Evans Army Community Hospital
Fort Carson, Colorado
Fairview Health Services                          DNP students only

Minneapolis, Minnesota
Family Health Care Center
Saint Louis, Missouri
Fayette Medical Center
Fayette, Alabama Paper work under DCH
Fletcher Allen Health Care
Burlington, Vermont
Florida Department of Health
Includes: Holmes County Health Dept.
                         UNIVERSITY OF SOUTH ALABAMA
                                COLLEGE OF NURSING
                                  December 13, 2011
                      Clinical Agency Affiliations and Locations
               Agency Name                                    Agency Requirements
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
Floyd Memorial Hospital and Health
Services
New Albany, Indiana
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 controlled
Baldwin Regional Medical Center          substances).
Foley, Alabama
Fort Smith HMA, LLC d/b/a Sparks         Nursing students wishing to participate under this Agreement must
                                         contact Theresa Phillips in Human Resources 479-441-5458 to set
Health System                            up an appointment to begin the screening and orientation process.
Fort Smith, Arkansas                     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.

Fort Walton Beach Medical Center                     Student must take Compliance test from agency prior to beginning
                                                     clinical rotation. Also exhibits must be completed. Agency requires
Ft. Walton Beach, Florida                            modified Letter of Notification – faculty please contact CON contracts
                                                     department.
Fox Army Health Center
Redstone Arsenal, Alabama
Franklin Primary Health Center, Inc.
Mobile, Alabama
Gaston Health Care, Inc. d/b/a                       Only for Acute Care Nurse Practitioner students.

CaroMont Health
Gastonia, North Carolina
George Regional Health Systems
Lucedale, Mississippi
Georgetown University Hospital                       The following items must be completed prior to student beginning
                                                     clinicals: Faculty provides syllabus to CON contract office as
Washington, D.C.                                     Attachment A, Dean must sign Attachment B, and student signs
                                                     Attachment D.
Georgia Dept. of Health, West Central
Health District
Columbus, Georgia
Georgia Health Science Health Inc.                   Please contact Angela McIntosh, Clinical Nurse Educator, at (706)
                                                     721-0305 or via email to amcintosh@georgiahealth.edu
(formerly Medical College of Georgia)
Augusta, Georgia
Georgia Southern University
Statesboro, Georgia
Goodwill Easter Seals Child
Development Center
Mobile, Alabama
Gordon Oaks Healthcare
Mobile Alabama
                         UNIVERSITY OF SOUTH ALABAMA
                                COLLEGE OF NURSING
                                   December 13, 2011
                      Clinical Agency Affiliations and Locations
               Agency Name                                    Agency Requirements
Grady Health System                       Students notify faculty prior to starting clinicals. Faculty should see
                                          contract person regarding exhibits for students to complete.
Atlanta, Georgia
Greenville Hospital University Medical    Students must complete Verification Form, Appendix C, and
                                          Appendix D prior to clinicals. All rotations must be approved through
Center                                    “Students Services Dept.” 4 months prior to start date.
Greenville, South Carolina
Gulf Coast Mental Health Center
Gulfport, Mississippi
Gulfport School District
Gulfport, Mississippi
Gundersen Lutheran – Internal
Medicine
La Crosse, Wisconsin
Gwinnett Hospital System, Inc.            NNP students only – preceptor Dr. Leslie Leigh;
                                          Students must review Exhibit “A” Permitted Activities of the Student
Lawrenceville and Duluth, Georgia
Hancock Medical Center
Bay St. Louis, MS
Harbin Clinic
Rome, Georgia
Hawaii Pacific Health                     Students must review Exhibit “A” Standards of Conduct

Honolulu, Hawaii
HCA Health Services of Tennessee,
d/b/a Centennial Medical Center
Nashville, Tennessee
HCA North Texas (includes Denton Regional Students must complete Exhibit A (Statement of Responsibility) and
                                          Exhibit B (Confidentiality Statement) prior to beginning clinical
Medical Center, Green Oaks Psychiatric Hospital,      rotation.
Las Colinas 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
Health Care Centers in Schools
Baton Rouge, Louisiana
Health District 8, Unit 2                             (Southwest Georgia Health District) (encompasses clinical facilities in
                                                      Georgia counties of Baker, Calhoun, Colquitt, Decatur, Dougherty,
Albany, Georgia                                       Early, Grady, Lee, Miller, Mitchell, Seminole, Terrell, Thomas &
                                                      Worth)
Healthsouth Rehab Corporation
Mobile, Alabama
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.
Hennepin County Medical Center                        Students must cooperate with HCMC in obtaining a Minnesota
                                                      Background study before beginning clinicals.
Minneapolis, Minnesota
Holmes County Department of Health
Bonifay, Florida
                          UNIVERSITY OF SOUTH ALABAMA
                                 COLLEGE OF NURSING
                                   December 13, 2011
                      Clinical Agency Affiliations and Locations
               Agency Name                                    Agency Requirements
Holmes Regional Medical Center           **Faculty please see me regarding “specific responsibilities”

Melbourne, Florida
Hospital Authority of Valdosta and
Lowndes County, GA d/b/a South
Georgia Medical Center
Huntsville Hospital
Huntsville, Alabama
Iasis Glenwood Regional Medical          Students must complete Exhibit A, “Confidentiality Statement” prior
                                         to beginning clinical rotation.
Center, LP
West Monroe, Louisiana
Iberia Medical Center (Jeanerette Rural
Health Center)
New Iberia, Louisiana
Idaho Department of Health and
Welfare State Hospital North
Orofino, Idaho
IHC Health Services, Inc.
(Intermountain Healthcare)
Salt Lake City, Utah
IMC-Diagnostic & Medical Clinic, P.C.
Mobile, Alabama
INTEGRIS Health, Inc.                                      Students must complete Exhibit A, Student Confidentiality
                                                           Agreement
Oklahoma City, Oklahoma
Jackson Hospital
Montgomery, Alabama
Jackson-Madison County General
Hospital,
West TN Healthcare
Jackson, Tennessee
Jeff Anderson Regional Medical Center
Meridian, Mississippi
Jewish Hospital & St. Mary’s                               Exhibits A & B must be completed prior to beginning clinical rotation.
                                                           In addition, School must verify negative status of Kentucky Board of
Healthcare, Inc. d/b/a Jewish Hospital                     Nursing Abuse Registry check prior to commencement of the clinical
Louisville, Kentucky                                       experience.

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
                            UNIVERSITY OF SOUTH ALABAMA
                                   COLLEGE OF NURSING
                                     December 13, 2011
                         Clinical Agency Affiliations and Locations
                    Agency Name                          Agency Requirements
Antioch, Mountain View, Davis, Petaluma, Fairfield,
Pleasanton, Fremont, Rancho Cordova, Fresno, Richmond,
Gilroy, Roseville, Martinez, San Jose, Novato, Stockton,
Napa, Vacaville, Milpitas




Kaiser Foundation Hospitals, Hawaii
Region and the Kaiser Foundation
Health Plan Inc., Hawaii Region
Keesler Medical Center, 81st Medical                       Master of Science in Nursing

Group,
Keesler AFB, Mississippi
Kenner Army Health Clinic (includes
Wilkerson Pediatric Clinic)
Fort Lee, Virginia
Kindred Healthcare Clinic
Green Cove Springs, Florida
Lakeland Medical Center
New Orleans, Louisiana
Lakeview Center, Inc.
Pensacola, Florida
Lakewood Ranch Medical Center
Bradenton, Florida
Lallie Kemp Medical Center
Independence, LA
Landstuhl Regional Medical Center
APO AE
Lee Memorial Health System
Cape Coral, Florida
Leonard J. Chabert Medical Center –
LSU Hospitals Health Care Services
Division
Houma, Louisiana
Little Sisters of the Poor Home for the
Aged, Inc.,
Mobile, Alabama
Littleton Regional Hospital
Littleton, New Hampshire
LSU Health Sciences Center                                 Faculty must submit in writing their requests for clinical sites for
                                                           each rotation. Contact USA contract dept for agency contact info.
Shreveport, Louisiana                                      Students must provide verification of negative TB skin test within the
                                                           past 12 months or follow up negative chest x-ray result.
Lyster U.S. Army Community Hospital                        Training for a Nursing Masters Degree

Fort Rucker, Alabama
                        UNIVERSITY OF SOUTH ALABAMA
                               COLLEGE OF NURSING
                                 December 13, 2011
                     Clinical Agency Affiliations and Locations
                Agency Name                                  Agency Requirements
Madison Nursing Center
Madison, Florida
Marengo Family Health Center
Demopolis, Alabama
Marshall Health System
Boaz, Alabama
Martin Army Community Hospital          BSN and graduate students

Fort Benning, Georgia
Martin Memorial Health Systems, Inc.
Stuart, Florida
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
Massachusetts General Hospital          Students must complete Confidentiality Agreement prior to beginning
                                        clinicals. Students must also review the following: “Physical Removal
(General Hospital Corp)                 & Transport of Protected Health Information & Personal Information,”
Boston, Massachusetts                   “Laptop Encryption Policy,” & “Portable USB Drive Encryption” in
                                        addition to completing the HEALTHSTREAM training module.
Matthew Walker Comprehensive Health
Center
Nashville, Tennessee
Maury Regional Hospital d/b/a Maury
Regional Medical Center
Columbia, Tennessee
Meadows Healthcare Alliance                         Only allows students into agency’s Wellness Center for sports
                                                    medicine clinicals.
Vidalia, Georgia
Meadows Regional Medical Center
Vidalia, Georgia
Medcenter One, Inc.                                 Preventive health requirement form has to be completed on student.
                                                    Student must complete Net Learning System. Faculty should contact
Bismarck, North Dakota                              Contract person at CON.
Medical Center of Louisiana at New                  *Name Alert* Due to Hurricane Katrina, this site has a new name
                                                    (Louisiana State University Interim Hospital)
Orleans or (LSU Interim Hospital)
New Orleans, Louisiana
Medical University Hospital Authority
Medical University of South Carolina
Charleston, South Carolina
Medicorp Health System (includes Mary
Washington Healthcare)
Fredericksburg, Virginia
MedWest Healthcare System to                        Students must review the online Academic Affiliate Clinical Rotation
                                                    Manual and complete required documents 4 weeks in advance of the
include: MedWest Haywood, MedWest                   start of the clinical experience. (Appendices A-E must be completed).
Harris, and Medwest Swain                           www.medwesthealth.org/academic_affiliate_orientation_manual.aspx

Clyde, North Carolina                               Faculty: please email contracts department for attachment.
Memorial Healthcare Group, Inc., d/b/a              Student must complete Exhibits A-C prior to beginning clinicals.

Memorial Hospital
                         UNIVERSITY OF SOUTH ALABAMA
                                COLLEGE OF NURSING
                                  December 13, 2011
                      Clinical Agency Affiliations and Locations
               Agency Name                            Agency Requirements
Jacksonville, Florida
Memorial Hermann Northwest Hospital              Students must complete Exhibit B prior to beginning clinicals.

Houston, Texas
Memorial Hermann-Texas Medical Center            Students please see Mary Margaret Evans@ site for required
                                                 paperwork prior to clinicals. Also Student Faculty requirements
and Children’s Memorial Hermann Hospital         in file.
Houston, Texas
Memorial Hermann The Woodlands                   Students must complete Exhibit B prior to beginning clinicals.

Hospital
The Woodlands, Texas
Memorial Hospital at Gulfport                    (Indoor and Outdoor) Tobacco free environment
                                                 Fingerprinting is required. Student pays $50 fee to hospital.
Gulfport, Mississippi
Memorial Hospital University Medical             Student must complete attachments A through G and
                                                 Verification of Student Information
Center
Savannah, Georgia
Mercy Care Services, Inc.
Atlanta, Georgia
Mercy Health Services
Baltimore, Maryland
Mercy Health System, Inc. (formerly St. Mary’s   Student must have 30 day advance approval from agency.
Health System)
Knoxville, Tennessee
Mercy Health System
Janesville, Wisconsin
Mercy Medical
Daphne, Alabama
Mercy Medical Center                             Exhibit A must be completed and signed by student.

Des Moines, Iowa
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.
Methodist Healthcare System of San               Non-MHS employees must go to MHS HIPAA and ethics
                                                 session prior to beginning clinicals.
Antonio, Ltd., L.L.P.                            *Employment verification required (for 7 years)
San Antonio, Texas
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.
Mississippi Baptist Health Systems, Inc.,
Mississippi Baptist Medical Center, Inc.,
and Mississippi Hospital for Restorative
Care, Inc.
Jackson, Mississippi
                        UNIVERSITY OF SOUTH ALABAMA
                               COLLEGE OF NURSING
                                 December 13, 2011
                     Clinical Agency Affiliations and Locations
               Agency Name                           Agency Requirements
Mississippi State Department of Health
Jackson, Mississippi
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
Moffitt Cancer Center                                      RN-BSN, BSN, RN-MSN, and DNP programs.
                                                           Schedule 4.8 Screenings and Vaccination
Tampa, Florida                                             Schedule 4.9 Student Letter Agreement, must be completed by
                                                           student.
Moncrief Army Community Hospital                           Family Psychiatric Nurse Practitioner students.

Fort Jackson, SC
Moses Cone Health System                                   A negative Twelve Panel Urine Drug Screen report test from a
                                                           National Institute of Drug Abuse (NIDA) approved laboratory on
Greensboro, North Carolina                                 file prior to the first assignment/student experience at MCHS
                                                           with USA CON.
Munroe Regional Medical Center                             Student must contact Workforce Development Coordinator with
                                                           Munroe to complete orientation packet prior to beginning
Ocala, Florida                                             clinicals.

Munson Medical Center
Transverse City, Michigan
Naples Community Hospital, NCH
Healthcare
Naples, Florida
Naval Health Clinic
Cherry Point, North Carolina
Naval Health Clinic New England                            Coordinators please see contract attachments.

Naval Branch Health Clinic
Groton, Connecticut
Naval Hospital                                             Contract includes: Allied Health students
                                                           Students are required to complete a confidentiality statement
Pensacola, Florida                                         prior to clinical experience (See faculty)
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.
Nebraska Methodist Hospital
                        UNIVERSITY OF SOUTH ALABAMA
                               COLLEGE OF NURSING
                                    December 13, 2011
                   Clinical Agency Affiliations and Locations
            Agency Name                               Agency Requirements
Omaha, Nebraska
Nemours Foundation (includes Children’s Clinic in
Destin, FL and the Alfred I. DuPont Nemours in
Wilmington, DE)
Pensacola, Florida
Neonatology Associates of Atlanta, P.C.
(Pediatrix)
Sunrise, Florida (corporate office)
NIH Clinical Center
Bethesda, Maryland
North Baldwin Infirmary
Bay Minette, Alabama
Northbay Healthcare Group d/b/a Northbay
Medical Center and Northbay Vaca Valley
Hospital
Fairfield, California
Northeast Georgia Medical Centers, Inc.          Graduate Students
(Northeast Georgia Health System)
Gainesville, Georgia

Northwestern Memorial Hospital                   Students must complete Exhibit 1 prior to clinicals.

Chicago, Illinois
North Memorial Health Care                       Minnesota RN license for Faculty required.

Robbinsdale, Minnesota
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
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.
North Okaloosa Medical Center
Crestview, Florida
Northeast Alabama Regional Medical
Center
Anniston, Alabama
Northport Medical Center
Northport, Alabama (paperwork under DCH)
NorthShore Regional Medical Center               Exhibits A & B must be signed by student

Slidell, Louisiana
NorthShore Specialty Hospital
Covington, Louisiana
Northside Hospital
                        UNIVERSITY OF SOUTH ALABAMA
                              COLLEGE OF NURSING
                                December 13, 2011
                    Clinical Agency Affiliations and Locations
               Agency Name                                  Agency Requirements
Atlanta, Georgia
Northwest Texas Healthcare System
Amarillo, Texas
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
Oak Hill Hospital                                       Students must complete Exhibits A & B prior to beginning
                                                        clinical rotation. USA CON must complete Exhibit C on behalf
Brooksville, Florida                                    of student(s).
Oakwood Healthcare, Inc.
Dearborn, Michigan
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 measles, mumps, rubella, and varicella
Includes all 32 regional clinics (Slidell, Covington,
etc.)
Ochsner Medical Center                                  Exhibits A & B will need student signatures

Kenner, Louisiana
Ochsner Medical Center, as part of Ochsner Clinic       Contract includes DNP Students.
                                                        Students must complete Exhibit A & B prior to starting clinicals
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.
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                 Faculty members please see me regarding attachment A prior
                                                        to student’s clinical experience
Arthur James Cancer Hospital and Richard
J. Solove Research Institute
Columbus, Ohio
Okaloosa County Health Dept.
Fort Walton Beach, Florida
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
                         UNIVERSITY OF SOUTH ALABAMA
                               COLLEGE OF NURSING
                                 December 13, 2011
                     Clinical Agency Affiliations and Locations
               Agency Name                                   Agency Requirements
Oklahoma City, Oklahoma                      faculty for detailed instructions.

Orange County Health Department
Hillsborough, North Carolina
Orlando Health, Inc.                         Schedule B Requirements for Participants on file

Orlando, Florida

OU Medical Center                                    Students are required to submit flu vaccinations information
                                                     and additional paperwork prior to clinicals to Steven Gifford via
Oklahoma City, Oklahoma                              fax to (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
                                                     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
Our Lady of Bellefonte Hospital
Ashland, Kentucky
Our Lady of the Lake Ascension
                                                     Students must complete Attachment 1 (Student Agreement),
Community Hospital, Inc. d/b/a St.                   Attachment 2 (Confidentiality Agreement), and Attachment 3
Elizabeth Hospital                                   (Statement of Responsibility) prior to beginning clinicals.
Gonzales, Louisiana
Our Lady of the Lake Ascension                       Students must complete Attachment 1 (Student Agreement),
                                                     Attachment 2 (Confidentiality Agreement), and Attachment 3
Community Hospital, Inc. d/b/a St.                   (Statement of Responsibility) prior to beginning clinicals.
Elizabeth Physicians, Inc.
Gonzales, Louisiana
Our Lady of the Lake Regional Medical                Prior to contacting agency, students must have a
                                                     background check, TB skin test, and a CURRENT (within 1
Center                                               semester) drug screen, and complete Attachments 1-3. If
Baton Rouge, Louisiana                               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
Our Neighborhood Healthcare Clinic
Mobile, Alabama
Palm Beach County Health Department,
Florida
West Palm Beach, Florida
Patient Care Services
Decatur, Georgia
PeaceHealth Oregon Region (Springfield,
                        UNIVERSITY OF SOUTH ALABAMA
                               COLLEGE OF NURSING
                                 December 13, 2011
                     Clinical Agency Affiliations and Locations
              Agency Name                                  Agency Requirements
Eugene, Creswell and Cottage Grove,
Oregon)
Pediatrics and Adolescent Medicine PC
Mobile, Alabama
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”
Phoenix Children’s Hospital                           Student must complete Attachments B & C prior to beginning
                                                      clinicals.
Phoenix, Arizona
Planned Parenthood of Arkansas and                    Arkansas Board of Nursing must be notified by faculty of
                                                      student name, licenses number, preceptor information, clinical
Eastern Oklahoma, Inc.                                site, course of enrollment and number of clinical hours.
Tulsa, Oklahoma
Planned Parenthood of Georgia, Inc.
Atlanta, Georgia

Planned Parenthood of Houston and
Southeast Texas, Inc.
Houston, Texas
Poarch Band Creek Indians Health
Department
Atmore, Alabama
Presbyterian Healthcare Services                      Student must sign and complete Exhibit B prior to beginning
                                                      clinicals.
Albuquerque, New Mexico
Presbyterian Hospital of Plano                        Course Coordinators-please complete attachments

Plano, Texas
Prince William Health District (Virginia
Department of Health)
Woodbridge, Virginia
Princeton Baptist Medical Center,
Birmingham, Alabama
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.

Providence Health & Services –                        Non-employees must: complete an Alaska background check;
                                                      orientation prior to beginning clinicals.
Washington d/b/a Providence Health &                  Faculty: Must provide agency with a list of students before
Services Alaska Region                                they begin clinicals.

Anchorage, Alaska
Providence Hospital
Mobile, Alabama
Public Health Division of the New Mexico
Department of Health
Santa Fe, New Mexico
R.E. Thomason General Hospital (El Paso               Students must complete agency’s Non-Disclosure Agreement
                                                      and attend orientation provided by the hospital prior to
County Hospital District)                             beginning clinicals.
                          UNIVERSITY OF SOUTH ALABAMA
                                COLLEGE OF NURSING
                                  December 13, 2011
                      Clinical Agency Affiliations and Locations
               Agency Name                                  Agency Requirements
El Paso, Texas
ReHab Care
Austin, TX or St. Louis, MO
Regional Medical Center of Acadiana           Students must sign Exhibits A and B prior to beginning
                                              clinicals.
Lafayette, Louisiana
River Oaks Hospital
Jackson, Mississippi
River Oaks Woman’s Hospital
Jackson, Mississippi
Riverside Healthcare Association, Inc.        Students must complete Attachment 110.D and 110.E
                                              prior to beginning clinicals. Students are also required to
Newport News, Virginia                        obtain and maintain their own liability insurance in the
                                                      amounts of $2 million per occurrence and $6 million
                                                      aggregate. As evidence of such coverage, students
                                                      must provide USA and Riverside with a copy of their
                                                      certificate of liability insurance prior to beginning
                                                      clinicals.
Rush Foundation Hospital(Rush Health Systems)
Meridian, Mississippi
Saad’s Health Care
Mobile, Alabama
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.
Samaritan Health Services, Inc.
Corvallis, Oregon
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.
Santa Rosa Public Health Department
Milton, Florida
Saraland City School System
Saraland, Alabama
Scott Memorial Hospital
Scottsburg, Indiana
Searcy Hospital
Mt. Vernon, Alabama
Sedgwick County Health Department
Wichita, Kansas
Select Specialty Hospital
Gulfport, Mississippi
Sentara Healthcare System (includes:                  Students must purchase additional professional liability
Sentara Bayside Hospital, Sentara Leigh               insurance (outside of USA) with limits of $1
                                                      million/occurrence and $3 million aggregate in order to
Hospital, Sentara Norfolk General Hospital,           intern at this site, since Virginia law requires higher
Sentara Careplex Hospital, Sentara Virginia           limits that the University offers.
Beach General Hospital, Sentara Williamsburg
Regional Medical Center, & Sentara Louise Obici
                          UNIVERSITY OF SOUTH ALABAMA
                                 COLLEGE OF NURSING
                                   December 13, 2011
                       Clinical Agency Affiliations and Locations
                  Agency Name                          Agency Requirements
Memorial Hospital)
Chesapeake, Virginia
Seton Medical Management, Inc.
Mobile, Alabama
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

Shriners Hospitals for Children               * Agreement begins effective term August 22, 2011.

Spokane, Washington
Singing River Hospital System, (Includes
Singing River and Ocean Springs Hospitals)
Pascagoula, Mississippi
Sisters of Charity Providence Hospital        Students should contact Ms. Soderstrom at agency for
                                              additional paperwork requirements prior to clinicals.
Columbia, South Carolina
Slidell Memorial Hospital & Medical Center,
Slidell, Louisiana
South Baldwin Family Practice, LLC
Foley, Alabama
South Broward Hospital District d/b/a         Masters in Nursing Program, Neonatal NP

Memorial Healthcare System
Hollywood, Florida
South Carolina Dept. Health and
Environment Control
Columbia, South Carolina
South Carolina Department of Mental
Health (Division of Inpatient Services)
Columbia, South Carolina
South Central Regional Medical Center         RN to BSN, graduate students
                                              Grad students please see Ms. Beth Endom
Laurel, Mississippi                           prior to starting
South Jersey Hospital, Inc. (aka Bridgeton
Mental Health Unit)
Bridgeton, New Jersey
Southeast Alabama Medical Center
Dothan, Alabama
Southeastern Emergency Physicians, Inc.
Knoxville, Tennessee
Southeastern Regional Primary Care
Corporation
                           UNIVERSITY OF SOUTH ALABAMA
                                 COLLEGE OF NURSING
                                   December 13, 2011
                       Clinical Agency Affiliations and Locations
               Agency Name                                    Agency Requirements
Vidalia, Georgia
South Mississippi Home Health, Inc.
Hattiesburg, Mississippi
Southwest Mississippi Regional Medical
Center
McComb, Mississippi
Springhill Memorial Hospital
Mobile, Alabama
St. Alphonsus Physicians Services, Inc.        Students must complete Attachments prior to starting
                                               clinicals—See faculty
Boise, Idaho
St. Cloud VA Medical Center
St. Cloud, Minnesota
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
St. Francis Medical Center, Inc.
Monroe, Louisiana
St. Francis Hospital                           Students must complete Exhibits A, B, & C prior to beginning
                                               clinicals.
Memphis, Tennessee
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.
St. Louis Children’s Hospital                  Faculty, please request a copy of the “additional terms” form
                                               prior to students beginning clinicals
St. Louis, Missouri
St. Mary’s Health System (now owned by         Student must have 30 day advance approval from agency.
Mercy Health System, Inc.)
Knoxville, Tennessee
Saint Mary’s of Michigan Standish Hospital
Saginaw, Michigan
St. Tammany Parish Hospital
Covington, Louisiana
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
St. Vincent Hospital of the Hospital Sisters             Agency requires letter of good standing and verification of
                                                         competency in sterile technique training for each student.
of the Third Order of St. Francis and St.
Mary’s Hospital Medical Center of Green
Bay, Inc.
Green Bay, Wisconsin
Summa Health System Hospitals
Akron, Ohio
Sutter General Hospital
                            UNIVERSITY OF SOUTH ALABAMA
                                    COLLEGE OF NURSING
                                        December 13, 2011
                        Clinical Agency Affiliations and Locations
               Agency Name                                      Agency Requirements
Sacramento, California
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
Tanner Medical Center, Inc.
Carrollton, Georgia
TCH Pediatric Associates, Inc. d/b/a Texas
Children’s Pediatric Associates
Houston, Texas
Tenet Health System GB, Inc. (dba Atlanta               Student attachments required prior to starting clinicals. Please
                                                        request Exhibit A and B from faculty.
Medical Center)
Atlanta, Georgia
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 Diabetes Center
Ocean Springs, Mississippi
The Little Clinic
Brentwood, Tennessee
The Medical Center, Inc.                                Student must carry their own occurrence-type general
                                                        and professional liability insurance coverage in amounts
Columbus, Georgia                                       not less than $1,000,000 per occurrence and
                                                        $3,000,000 annual aggregate.
The Toledo Hospital
Toledo, Ohio
The University of Texas Medical Branch at               Correctional Managed Care department and Ob-Gyn
                                                        Department (Regional Maternal & Child Health Programs)
Galveston
Galveston, Texas
Thibodaux Regional Medical Center
Thibodaux, Louisiana
Thomas Hospital
Fairhope, Alabama
Touro Infirmary                                         Faculty must complete Exhibit A. Student must complete
                                                        Exhibit B prior to clinicals.
New Orleans, Louisiana
Triad of Alabama, LLC d/b/a Flowers                     Faculty shall review Addendum 1 & 2 with student prior
                                                        to student’s clinical rotation
Hospital
Dothan, Alabama
Tripler Army Medical Center
Honolulu, Hawaii
Trinity Medical Center (formerly Montclair
Baptist Medical Center)
                        UNIVERSITY OF SOUTH ALABAMA
                               COLLEGE OF NURSING
                                 December 13, 2011
                     Clinical Agency Affiliations and Locations
               Agency Name                                   Agency Requirements
Birmingham, Alabama
Trover Foundation/Trover Health Services     Students must provide copies of all immunization records to the
                                             site Clinical Education coordinator
Madisonville, Kentucky
Tulane University Medical Group (Department
of Pediatrics)
New Orleans, Louisiana
Twin Cities Hospital
Niceville, Florida
United HealthCare Services, Inc.                        Students must complete attachments prior to clinicals-See
                                                        faculty
d/b/a Evercare Georgia,
Norcross, Georgia
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
U.S. Army Health Clinic Vilseck                         rotation will expose 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.
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 Arizona, College of Nursing               Student must be approved prior to beginning clinicals

Tucson, Arizona
University of Florida, College of Medicine,
OBGYN Department
Pensacola, Florida
University Health System, Inc.                          Student must complete Exhibits A & B prior to beginning
                                                        clinicals
Knoxville, Tennessee
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.
University of Kentucky Medical Center
Lexington, Kentucky
University of Maryland Medical Center                   Student must complete Attachment A prior to beginning
                                                        clinicals.
Baltimore, Maryland
University of Michigan Health System
Ann Arbor, Michigan
University of Minnesota Physicians
Minneapolis, Minnesota
                          UNIVERSITY OF SOUTH ALABAMA
                                COLLEGE OF NURSING
                                   December 13, 2011
                      Clinical Agency Affiliations and Locations
               Agency Name                                 Agency Requirements
University of Mississippi Medical Center
Jackson, Mississippi
University of New Mexico Hospital             Agency requires student(s) be complete drug screening within
                                              6 months before beginning clinicals at UNMH. Faculty to
Albuquerque, New Mexico                       complete Exhibit A. Student(s) must provide UNMH and USA
                                                       CON with copy of certificate of insurance as proof of their
                                                       property damage coverage.
University of South Alabama Hospitals
Mobile, Alabama
USA Mitchell Cancer Institute
Mobile, Alabama
University of South Carolina
Columbia, South Carolina
University of Virginia Health System                   Nurse Practitioner Agreement

Charlottesville, Virginia

University Medical Center, Inc. d/b/a                  Students must fulfill requirements as outlined in Exhibit A and
                                                       sign Exhibit B (Statement of Understanding and Confidentiality
University of Louisville Hospital/James                Agreement)
Graham Brown Cancer Center
Louisville, Kentucky
University Medical Center of El Paso                   Students please see agency contract specialist regarding
                                                       special instructions/attachments required before clinicals
(formerly R.E. Thomason General Hospital)
El Paso, Texas
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.
Vanderbilt University (Hospital, Clinic,               Clinical rotation criteria and background investigation.

Children’s Hospital)
Nashville, Tennessee

Central Alabama Veterans Healthcare                    BSN and MSN

System
Montgomery and Tuskegee Alabama
James A. Haley Veterans Hospital                       RN-BSN, Master of Science, Doctor of Nursing Practice

Tampa, Florida
Tennessee Valley Healthcare System                     Master of Science

Nashville, Tennessee
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 Central Iowa Health Care System                     CNL students only

Knoxville and Des Moines Divisions
VA Greater Los Angeles Healthcare                      Master of Science

System
Los Angeles, California
Veterans Affairs Gulf Coast Healthcare                 Nursing: BSN, MSN, and graduate students
                                                       Agency requires Trainee Qualifications and Credentials
                      UNIVERSITY OF SOUTH ALABAMA
                             COLLEGE OF NURSING
                               December 13, 2011
                   Clinical Agency Affiliations and Locations
              Agency Name                          Agency Requirements
System                                   Verification Letter (TQCVL) signed by Program Director.

Biloxi, Mississippi
VA Healthcare Center of Bay Pines        BSN, MSN, DNP
                                         Student must contact agency to be fingerprinted 1 month prior
Bay Pines, Florida                       to rotation. Student cannot begin until results are back.
VA Healthcare System of Roseburg         MSN, Post-Masters Advanced Psychiatric-Mental Health
                                         (NP/CNS) programs
Roseburg, Oregon
VA Hospital Denver
Denver, Colorado
VA Medical Center of Alexandria, LA      Gerontological/Adult Psychiatric NP (On-Line) Bachelor and
                                         Master
Alexandria, Louisiana
VA Medical Center of Ann Arbor           Nursing Program, Master’s

Ann Arbor, Michigan
VA Medical Center of Asheville, NC       Advanced Practice Nursing

Asheville, North Carolina
VA Medical Center of Atlanta             MSN in Gerontology NP
                                         RN-BSN-MSN
Atlanta, Georgia
VA Medical Center of Birmingham          BSN-MSN

Birmingham, Alabama
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
VA Medical Center of Cheyenne            Nursing/Nurse Practitioner/MS

Cheyenne, WY
VA Medical Center of Dayton, OH          Master in Nursing

Dayton, Ohio
VA Medical Center of Eastern Kansas      MSN and NP Degree Programs

Leavenworth & Topeka, Kansas
VA Medical Center of Fayetteville        Family Psychiatric NP students only

Fayetteville, North Carolina
VA Medical Center of Grand Junction      MSN students

Grand Junction, Colorado
VA Medical Center of Huntington
Huntington, West Virginia
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)
VA Medical Center of Marion, IL          Master of Science

Marion, Illinois
VA Medical Center of Memphis, TN
                                 UNIVERSITY OF SOUTH ALABAMA
                                     COLLEGE OF NURSING
                                       December 13, 2011
                           Clinical Agency Affiliations and Locations
                Agency Name                                      Agency Requirements
Memphis, Tennessee
VA Medical Center of Michael DeBakey
Center
Houston, Texas
VA Medical Center of New Mexico                    BSN and MSN

Albuquerque, New Mexico
VA Medical Center of New Orleans                   Master of Science

New Orleans, Louisiana
VA Medical Center of Northhampton, MA              Graduate Degree

Leeds, MA
VA Medical Center of Overton Brooks                Undergraduate & Graduate degrees in Science of Nursing
                                                   TQCVL Paperwork in file.
Shreveport, Louisiana
VA Medical Center of Portland, OR                  Gerontological/Adult Psychiatric, Masters

Portland, Oregon
VA Medical Center–South Central OK                 Master of Science, Nurse Practitioner (MS)

Oklahoma City, Oklahoma
VA Medical Center of St. Louis, MO
St. Louis, Missouri
VA Medical Center of Tuscaloosa, AL                BSN and MSN

Tuscaloosa, Alabama
Veterans Affairs North Texas Medical               Advanced Geropsych Assessment Older Adults Practicum RN-
                                                   BSN-MSN
Center                                             Master of Science in Nursing
Dallas, Texas
Veterans Affairs North Florida/South               RN-BSN/BSN & MSN

Georgia Health System
Gainesville, Florida
Veterans Affairs Outpatient Clinic                 Graduate Program,
                                                   Master of Science in Nursing
Chattanooga, Tennessee
VA Pacific Islands Health Care System              MSN students only

Honolulu, Hawaii
VA Phoenix Healthcare System
Phoenix, Arizona
VA Puget Sound Health Care System
Seattle, Washington
Vicksburg Healthcare, LLC d/b/a River              Students must submit to substance abuse testing every 12
                                                   months (to test for presence of alcohol, drugs, or other
Region Health System                               controlled substances).
Vicksburg, Mississippi
Victory Health Partners
Mobile, Alabama
Virginia Commonwealth University Health
System (Medical College of Virginia)
Richmond, Virginia
Wake Forest University Baptist Medical             For Clinical Faculty and Students additional on-site
                                                   requirements may include participating in orientation, on
                         UNIVERSITY OF SOUTH ALABAMA
                                COLLEGE OF NURSING
                                  December 13, 2011
                      Clinical Agency Affiliations and Locations
              Agency Name                                    Agency Requirements
Center (North Carolina Baptist Hospital)      site HIPAA and other training, submission to a TB test,
                                              submission of a criminal background check, a 10 panel
Winston-Salem, North Carolina                 drug screen, and proof of a seasonal flu vaccine.
Walton County Health Department
Defuniak Springs, Florida
WellStar Health System, Inc.                  Only WellStar employees are eligible. Students must complete
                                              an orientation packet prior to beginning any clinical rotation.
Marietta, Georgia
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
Wesley Medical Center                         “Student Agreement Only”-Students should complete a Term
                                              Sheet from the agency Now includes FNP students
Hattiesburg, MS
West Florida Hospital
Pensacola, Florida

West Georgia Medical Center
LaGrange, Georgia
Westminister Village
Spanish Fort, Alabama
Western State Hospital—DSHS Mental
Health Division
Olympia, Washington
Whatley Health Services
Tuscaloosa, Alabama
White-Wilson Medical Center                             Advanced Registered NP Agreement (agency requires
                                                        separate agreement for each student). FACULTY –
Fort Walton Beach, Florida                              please distribute 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.
William Beaumont Army Medical Center                    Family Nurse Practitioner students
                                                        (Agreement applies to only one trainee at a time).
El Paso, Texas
Wolfson Children’s Hospital
Jacksonville, Florida
Womack Army Medical Center                              For MSN students only – No more than two (2) trainees
                                                        annually
Ft. Bragg, North Carolina
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.
Zablocki VA Medical Center
Milwaukee, Wisconsin

				
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