UNIVERSITY OF SOUTH ALABAMA

					                         UNIVERSITY OF SOUTH ALABAMA
                                COLLEGE OF NURSING
                                 September 20, 2012
                      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
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 Barnwell MHC (South Carolina       Student must provide proof of vaccines prior to beginning clinicals.

Department of Mental Health)
Alabama Department of Public Health,
(Alabama inclusive)
Alabama Department of Rehabilitation
Services
Mobile, AL
Alegent Health
Omaha, Nebraska
Allegan Healthcare Group                 Faculty and Students please read Exhibit A.

Allegan, Michigan
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. Students please read new
                                                      guidelines from Allina.
AltaPointe Health Systems, Inc. (formerly
Mobile Mental Health)
Mobile, Alabama
Altru Health Systems (renewing)                       Students and Faculty: Request to see Addendum under
                                                      Agreement Attachments.
Grand Forks, North Dakota
Appling Health Care System
St. Baxley, Georgia
Arkansas Children’s Hospital
(renewing)
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
                         UNIVERSITY OF SOUTH ALABAMA
                                COLLEGE OF NURSING
                                 September 20, 2012
                      Clinical Agency Affiliations and Locations
                 Agency Name                          Agency Requirements
                                                  enrollment and number of clinical hours.
AtlantiCare Regional Medical Center
Egg Harbor Township, New Jersey
Aurora Medical Group, Inc.                        To include all Aurora Health Care, Inc. facilities.

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
Pensacola, Florida                                starting clinicals and bring with you to the Baptist
Includes: Baptist Hospital, Pensacola, FL         Health Care Orientation. Must be completed before
          Gulf Breeze Hospital, Gulf Breeze, FL   clinicals.
          Atmore Community Hospital, Atmore, AL
          Baptist Medical Group, Pace, FL         Attestation Form must be completed and signed by
                                                  USA Faculty and emailed to Barbara Hamilton-
                                                  barbara.hamilton@bhcpns.org
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      (renewing)
Baptist Hospital of Miami (to include:            Faculty must complete Schedule A. Student must complete the
                                                  Student Agreement and Acknowledgement form. Faculty must
Doctors Hospital, Inc., Homestead Hospital,       have active Florida license and CPR Certification. Please
Inc., South Miami Hospital, Inc., Mariners        ask for Section 9 School Certification forms.
Hospital, Inc., West Kendall Baptist Hospital,
Inc., and Baptist Outpatient Services, Inc.,)
Baptist Medical Center South (includes            Students must complete required training before beginning training
                                                  and sign an individual agreement with agency (Attachment A).
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-Florida
Department of Health
Panama City, Florida

Bay Medical Center – Sacred Heart
Health System
Panama City, Florida
                         UNIVERSITY OF SOUTH ALABAMA
                               COLLEGE OF NURSING
                                September 20, 2012
                    Clinical Agency Affiliations and Locations
              Agency Name                                   Agency Requirements
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.
                                                    Health and must have a MS background check prior to background
                                                    screening attestation form (Exhibit C) being completed by University
                                                    Official. Faculty must provide schedule for the length of time the
                                                    students will be in the facility 14 days prior to rotation.
Blanchfield Army Community Hospital
Fort Campbell, Kentucky
BMA of Alabama (Dialysis Outpatient
Clinic)
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.
(renewing)
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.
Bryan LGH Medical Center
Lincoln, Nebraska
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
Catawba Valley Medical Center
Hickory, NC
Cathedral Place Apartments
                          UNIVERSITY OF SOUTH ALABAMA
                                 COLLEGE OF NURSING
                                  September 20, 2012
                       Clinical Agency Affiliations and Locations
               Agency Name                                     Agency Requirements
Mobile, Alabama (renewing)
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
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 (covers Students must complete Exhibits A, B-1, and C prior to clinical.
Egleston and Scottish Wright)
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. FACULTY, PLEASE NOTE: Our
                                                     one page agreement is not required. Children’s Hospital of Alabama
                                                     has a Form of Preceptor Assignment (Exhibit 1.2) this form does not
                                                     require USA Faculty signature. Form Exhibit 1.2 will be accepted in
                                                     lieu of our one page agreement. USA does require a signed copy of
                                                     Exhibit 1.2 for our records.
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
                         UNIVERSITY OF SOUTH ALABAMA
                                COLLEGE OF NURSING
                                  September 20, 2012
                     Clinical Agency Affiliations and Locations
                Agency Name                                Agency Requirements
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
Cook Children’s Hospital (to include the Students must complete Exhibits A & B prior to beginning clinicals.
Physician Network)
Fort Worth, Texas


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                                Faculty must verify that the student has received the required
                                                    flu vaccination and supply documentation as such to the
                                                    facility.
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.
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 Hospital Authority (includes Fayette
Medical Center, Northport Medical Center)
Tuscaloosa, Alabama (renewing)
DSHS Mental Health Division (Western
State Hospital)
Olympia, Washington
Dallas County Hospital District d/b/a               Nurse Practitioner students only. Faculty: Please ask Contract Office
                                                    for the following forms, all must be typed and completed entirely and
                        UNIVERSITY OF SOUTH ALABAMA
                              COLLEGE OF NURSING
                                September 20, 2012
                    Clinical Agency Affiliations and Locations
              Agency Name                                 Agency Requirements
Parkland Health & Hospital System      may be faxed or scanned to Kim at 214-590-6947
                                       kimberly.nelson@phhs.org.
Dallas, Texas                          Clinical Request Form-to request any rotations at Parkland.
                                                 Verification Letter- document states that the students listed all meet
                                                 the requirements under the current contract on file. Students
                                                 MUST have background check and 10 panel drug
                                                 screen within 30 days of beginning clinicals.
                                                 Students must complete to following-type and filled out entirely.
                                                 Badge Request-please fax or scan to Kim at 214-590-6947 or
                                                 Kimberly.nelson


Darnall Army Community Hospital                  Program leads to Masters of Science in Nursing in Community/Public
                                                 Health Nursing
Fort Hood, Texas


Dauterive Hospital (renewing)
New Iberia, Louisiana
Dekalb Medical Center                            Nurse Practitioner Agreement to include DNP students.

Decatur, Georgia
Delta Regional Medical Center
(renewing)
Greenville, Mississippi
Denver Health and Hospital Authority             Term for each student must be agreed upon at least (1) one month
                                                 prior to the start of clinicals in writing. Faculty must send facility the
Denver, Colorado                                 name of each Student enrolled in clinicals, along with the
                                                 Attestation Letter (available from the contract office) 30 days
                                                 prior to clinicals (to provide evidence of: Immune status for
                                                 Measles, Mumps, Rubella, and Varicella for Measles, Mumps,
                                                 Rubella must provide evidence of two doses of MMR vaccine if
                                                 born after 1957, or positive measles, mumps, rubella titers) and
                                                 has completed immunication for Hepatitis B or letter of
                                                 declination on file. prior to the beginning of clinicals. Students that
                                                 work with 12 month olds or younger shall be required to furnish
                                                 regarding immunizations and booster protection against pertussis.
                                                 Student must have had a PPD test in the past year. If student shows
                                                 a past history of positive TB skin test, must show evidence of an
                                                 annual assessment to rule out active TB. Students must have
                                                 received annual influenza vaccine or declination on file. Seasonal
                                                 influenza vaccination is required of all Students rotating at facility
                                                 between October and March of each year. Students must obtain
                                                 Workers Compensation Insurance through facility at the
                                                 Student’s expense. Students must carry health insurance
                                                 coverage under an accident and sickness health insurance plan.
                                                 Students must be 18 years or older.
Doctors Hospital of Augusta (expired-            Students must complete Exhibit B as well as the Statement of
                                                 Responsibility prior to starting clinicals (see faculty)
renewing)
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
                        UNIVERSITY OF SOUTH ALABAMA
                               COLLEGE OF NURSING
                                September 20, 2012
                     Clinical Agency Affiliations and Locations
                Agency Name                          Agency Requirements
                                           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
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                       Exhibit A: Faculty please read. Exhibit B: Student
Manchester, New Hampshire                  Confidentiality Agreement.
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 pass a test for illegal drugs and
                                           unprescribed medications within the 12 months preceding
                       UNIVERSITY OF SOUTH ALABAMA
                              COLLEGE OF NURSING
                               September 20, 2012
                    Clinical Agency Affiliations and Locations
               Agency Name                                Agency Requirements
Family Medicine)                       each referral or re-referral.Students must complete
                                       Addendum 1 & 2. Nurse Practitioner must complete
Hartford, Alabama                      Addendum 3, 4 and 5.
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 (renewing)
Saint Louis, Missouri
Fayette Medical Center (DCH Hospital
Authority)
Fayette, Alabama
First Health of the Carolinas                 Faculty and Students please read the Policy and Procedures.
                                              Available from the Contracts Office. Faculty must complete the
Pinehurst, North Carolina                     Clinical Assessment Check list.
Fletcher Allen Health Care
Burlington, Vermont
Florida Department of Health
Includes: Holmes County Health Dept.
Bonifay, Florida
Florida Hospital (Adventist Health            Student must be N-95 respirator fit tested prior to attending clnical.
                                              Testing can be done for $25 at the Agency clinic. General Nursing
System/Sunbelt, Inc.)                         and PT Students please see Exhibit C –Criminal Background
Maitland, Florida                             Disqualifications Guidelines.

Florida State Hospital
Chattahoochee, Florida
Floyd Memorial Hospital and Health
Services
New Albany, Indiana
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 –Students must have a 10 panel drug
                                              screen, faculty please contact CON contracts department.
Fox Army Health Center
Redstone Arsenal, Alabama
Franklin Primary Health Center, Inc.
Mobile, Alabama
Frederick Memorial Hospital                   Faculty and Students please read the Policies and Procedures
                                              manual.
Frederick, Maryland
Gaston Health Care, Inc. d/b/a                Only for Acute Care Nurse Practitioner students.
                         UNIVERSITY OF SOUTH ALABAMA
                                COLLEGE OF NURSING
                                 September 20, 2012
                      Clinical Agency Affiliations and Locations
              Agency Name                                      Agency Requirements
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
Iasis Glenwood Regional Medical                    Students must complete Exhibit A, “Confidentiality Statement” prior
                                                   to beginning clinical rotation.
Center, LP d/b/a Glenwood Regional
Medical Center
West Monroe, Louisiana
Goodwill Easter Seals Child
Development Center
Mobile, Alabama
Gordon Oaks Healthcare
Mobile Alabama
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 (renewing)
Gulf Coast Medical Center
Panama City, Florida
Gulf Coast Mental Health Center
Gulfport, Mississippi (renewing)
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
                         UNIVERSITY OF SOUTH ALABAMA
                                COLLEGE OF NURSING
                                   September 20, 2012
                      Clinical Agency Affiliations and Locations
               Agency Name                                    Agency Requirements
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. Faculty please send completed Attestation Form to the
Las Colinas Medical Center, Medical Center of         hospital in which your student is using as a clinical site.
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
Hilton Head Hospital                                  Students must complete Exhibits A, B, and C. Exhibit C must be
                                                      signed by the Dean.
Hilton Head, North Carolina
Holmes County Department of Health
Bonifay, Florida
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 (renewing)
Huntsville, Alabama
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.
                          UNIVERSITY OF SOUTH ALABAMA
                                COLLEGE OF NURSING
                                 September 20, 2012
                      Clinical Agency Affiliations and Locations
                Agency Name                                  Agency Requirements
(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
James A. Haley Veteran’s Hospital
Tampa, Florida
Jane Phillips Health Corporation
Bartlesville, Oklahoma
Jeff Anderson Regional Medical Center
Meridian, Mississippi (renewing-
expired)
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
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
                           UNIVERSITY OF SOUTH ALABAMA
                                  COLLEGE OF NURSING
                                   September 20, 2012
                        Clinical Agency Affiliations and Locations
                 Agency Name                                 Agency Requirements
Kindred Healthcare Clinic (renewing)
Green Cove Springs, Florida
Lafayette General Medical Center           9 panel drug screen

Lafayette, Louisiana
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
Lone Star Circle of Care
Georgetown, Texas


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                     Exhibit A and A #2.
(Earl K. Long Medical Center to close      Students must provide verification of negative TB skin test within
inpatient services as of May 2013)        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
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
                        UNIVERSITY OF SOUTH ALABAMA
                               COLLEGE OF NURSING
                                September 20, 2012
                     Clinical Agency Affiliations and Locations
                Agency Name                                  Agency Requirements
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 Central Georgia
Macon, Georgia
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 (renewing)                    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
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
                        UNIVERSITY OF SOUTH ALABAMA
                              COLLEGE OF NURSING
                               September 20, 2012
                    Clinical Agency Affiliations and Locations
               Agency Name                           Agency 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.
(also to include, Memorial Physician Clinics,
Magnolia Grove Healthcare)
Gulfport, Mississippi
Memorial Hospital University Medical             Student must complete attachments A through G and
                                                 Verification of Student Information
Center
Savannah, Georgia (renewing)
Mercy Care Services, Inc.
Atlanta, Georgia
Mercy Health Services/Mercy Medical
Center
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
Meriter Health Services, Inc.                    USA Faculty must notify Meriter Hospital Medical Affairs Health
                                                 Services and the Family Psychiatric Mental Health Practitioner
Madison, Wisconsin                               in advance with participating student names and affiliation
                                                 dates. Students must check in with Medical Affairs for a 10-
                                                 minute orientation on the first day, or prior to, the start of
                                                 clinical rotation.
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
                          UNIVERSITY OF SOUTH ALABAMA
                               COLLEGE OF NURSING
                                September 20, 2012
                     Clinical Agency Affiliations and Locations
               Agency Name                                  Agency Requirements
Methodist LeBonheur Healthcare               Students must sign Exhibit A (Hepatitis Statement) prior to
                                             beginning clinicals.
Memphis, Tennessee
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
Mississippi State Department of Health
Jackson, Mississippi
Mississippi State Hospital (renewing)
Whitfield, Mississippi
Mobile County Health Department
Mobile, Alabama
Mobile County Public Schools
Mobile, Alabama

Mobile Infirmary Association (includes: Mobile             Faculty must provide Sharon Jones (@ Mobile Infirmary
                                                           435-5089) with spreadsheet with list of NP students.
Infirmary Medical Center, North Baldwin Infirmary,         Students must complete a 45 minute Healthstream module
Infirmary West, Infirmary LTAC Hospital, E.A. Roberts      for orientation. Once the module has been completed by
Alzheimer’s Center, Thomas Hospital, & Northside Clinic)   student the Letter of Notification will be returned along
Mobile, Alabama                                            with the student badge and parking decal.

Mobile Nursing and Rehabilitation Center,
LLC
Mobile, Alabama
Mobile Ob-Gyn, P.C.
Mobile, Alabama
Moffitt Cancer Center (renewing)                           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.

Naples Community Hospital, NCH
Healthcare
Naples, Florida (renewing)
Naval Health Clinic
Cherry Point, North Carolina
Naval Health Clinic New England                            Coordinators please see contract attachments.
                         UNIVERSITY OF SOUTH ALABAMA
                               COLLEGE OF NURSING
                                September 20, 2012
                     Clinical Agency Affiliations and Locations
               Agency Name                                    Agency Requirements
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
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

Northwest Missouri Psychiatric Rehab
Center
St. Joseph, Missouri
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     (renewing)
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.
                         UNIVERSITY OF SOUTH ALABAMA
                               COLLEGE OF NURSING
                                  September 20, 2012
                     Clinical Agency Affiliations and Locations
               Agency Name                           Agency Requirements
North Okaloosa Medical Center
Crestview, Florida
Northeast Alabama Regional Medical
Center
Anniston, Alabama
Northport Medical Center (DCH Hospital
Authority)
Northport, Alabama
NorthShore Regional Medical Center                      Exhibits A & B must be signed by student

Slidell, Louisiana
NorthShore Specialty Hospital
Covington, Louisiana
Northside Hospital
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
Nurse Practitioner On Call
Pensacola, Florida
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. Faculty please ask
                                                        for the Attestation sheet.
New Orleans, Louisiana
Includes all 32 regional clinics (Slidell, Covington,
etc.)
Ochsner Medical Center                                  Exhibits A & B. Faculty please ask for the Attestation sheet.

Kenner, Louisiana (renewing)
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) Faculty please ask for Attestation
Includes: East Baton Rouge Medical Ctr.                 sheet.
New Orleans, Louisiana
                          UNIVERSITY OF SOUTH ALABAMA
                                COLLEGE OF NURSING
                                   September 20, 2012
                      Clinical Agency Affiliations and Locations
               Agency Name                                    Agency Requirements
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 Area Indian Service (Lawton
Indian Hospital)
Lawton, 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
Oklahoma City, Oklahoma                                 faculty for detailed instructions. Once the student completes the
                                                        online HIPAA training , they will be able to print a certificate.
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 (OU Medical                     fax to (405) 271-7344. Students must review the orientation
Center, The Children’s Hospital at OU Medical,          information online prior to beginning clinicals. (see website
                                                        below) Faculty should contact Contract person at CON with any
and OU Medical Center Edmond)                           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 Community
                                                        Students must complete Attachment 1 (Student Agreement),
Hospital, Inc. d/b/a St. Elizabeth Hospital             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 Physician Group, LLC               Students must complete Attachments 1-3 prior to beginning
                        UNIVERSITY OF SOUTH ALABAMA
                               COLLEGE OF NURSING
                                September 20, 2012
                     Clinical Agency Affiliations and Locations
               Agency Name                                 Agency Requirements
Baton Rouge, Louisiana                       clinicals.

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.
                                                     To include PNP program.
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,
Eugene, Creswell and Cottage Grove,
Oregon)
Pediatrics and Adolescent Medicine PC
Mobile, Alabama
Phoebe Putney Memorial Hospital
Albany, Georgia
Phoenix Children’s Hospital                          Student must complete Attachments B & C prior to beginning
                                                     clinicals.
Phoenix, Arizona
Piedmont Healthcare, Inc.                            Must provide student placement coordinator a statement that
                                                     student has a negative drug screen and background check.
Atlanta, Georgia                                     Student must all orientation paperwork on the following
                                                     website: www.piedmont.org/studentorientation . Faculty will
                                                     need to sign the signature page verifying the student has
                                                     reviewed the material.
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 Houston and
Southeast Texas, Inc.
Houston, Texas


Planned Parenthood Southeast, Inc.
Atlanta, Georgia
Plantation General Hospital                          Students must complete Exhibits A, B, & C before
                                                     beginning clinicals. NNP students must have signed
                          UNIVERSITY OF SOUTH ALABAMA
                                COLLEGE OF NURSING
                                  September 20, 2012
                      Clinical Agency Affiliations and Locations
                Agency Name                                Agency Requirements
Plantation, Florida                           agreement with Sheridan.
Poarch Band Creek Indians Health
Department
Atmore, Alabama
Presbyterian Healthcare Services (to          Student must sign and complete Exhibit B prior to beginning
                                              clinicals.
include Presbyterian Rust Medical Center
and Lincoln County Medical Center)
Albuquerque, New Mexico
Presbyterian Hospital of Plano (renewing)     Course Coordinators-please complete attachments

Plano, Texas


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


ReHab Care (renewing)
Austin, TX or St. Louis, MO


Regional Medical Center of Acadiana                     Students must sign Exhibits A and B prior to beginning
                                                        clinicals.
Lafayette, Louisiana (renewing)

Regional Medical Center at Memphis                      Faculty must confirm health status of students, provide written
                                                        student/faculty (if applicable) evaluations of each clinical
(Shelby County Healthcare Corp.)                        rotation, and provide a copy of the curriculum, clinical
                                                        objectives and students’ skill and competency levels.
River Oaks Hospital
Jackson, Mississippi
River Oaks Woman’s Hospital
Jackson, Mississippi
                        UNIVERSITY OF SOUTH ALABAMA
                               COLLEGE OF NURSING
                                  September 20, 2012
                     Clinical Agency Affiliations and Locations
               Agency Name                                 Agency Requirements
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.
Rockdale Medical Center
Conyers, Georgia
Roper St. Francis Healthcare                           The student must show written documentation of
                                                       the following:
Charleston, South Carolina                             Hepatitis B vaccination or refussal
                                                       Negative Tuberculin Skin Test (TST) must have been
                                                       tested within the last 12 months or documentation of
                                                       negative two step TST.
                                                       Student's immunity history for varicella, rubella, and
                                                       rubeola. ( If previous rubella is not in the history, and
                                                       titer is negative, a rubella vaccine shall be required.
                                                       Influenza vaccine within the past twelve months or
                                                       refussal.
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.
Saint Alphonsus Regional Medical Center                Faculty and Students please see Attachments A-1, A-2, B, and
                                                       the signature page, available through the Contracts Office.
Boise, Idaho                                           Saint Alphonsus requires a negative TB skin test or chest x-ray
                                                       within the last 12 months, a hepatitis B vaccination or
                                                       documentation of positive HB Sab, or a signed declination,
                                                       verification of varicella (chicken pox) status.
Saint Francis Medical Center                           Student must complete and sign Exhibit A. Faculty please see
                                                       Exhibt B.
Grand Island, Nebraska
Saint Luke’s Hospital of Bethlehem (to include         Faculty:
locations at: 801 Ostrum St. Bethlehem, 1736           Faculty and Agency will agree to the number of students, their
                                                       schedule and dates of admission at least (6) six weeks prior the
Hamilton Blvd. Allentown, PA, 1872 Riverside Circle,
                                                       date of admission. The specific days and hours of the student’s
Easton, PA, St. Luke’s Quakertown Hospital, St.        activities at St. Luke’s Health System will be mutually agreed
Luke’s Miners Memorial Hospital, Visiting Nurse’s      upon by both parties.
Assoc. of St. Luke’s, Home Health/Hospice, Inc. and    Upon request Faculty will complete the Request for Clinical
St. Luke’s Physician Group, Inc.)                      Education Affiliation Agreement, in the form Exhibit 1 available
                                                       through the Contracts Office.
                                                       Students:
                                                       Background Check:
                                                       Student must complete and submit to agency the following:
                                                                a. Student registration form.

                                                                  b.   Student statement of responsibility.

                                                                  c.   Student must maintain and provide evidence of
                                                                       current CPR certification for the duration of
                                                                       clinicals .
                      UNIVERSITY OF SOUTH ALABAMA
                             COLLEGE OF NURSING
                              September 20, 2012
                   Clinical Agency Affiliations and Locations
              Agency Name                          Agency Requirements
                                                   d.   Students shall be responsible for maintaining
                                                        health insurance coverage while in clinicals.

                                         Drug Screen:
                                         Must have a clear 5 panel urine drug screen test administred
                                         by an HHS-certified lab to include: 1.amphetaphines,
                                         2.cocaine, 3.cannabinoids, 4.opiates (including morphine,
                                         codeine, hydromorphone, and hydrocodone) and 5.
                                         phencyclidine. Drug Screen Test: Drug Test must be
                                         administered no earlier than 30 days prior to the
                                         date of beginning clinicals.
                                         Such other health related information and/or testing as may be
                                         requested by St. Luke’s Health System from time to time.
                                          Faculty and Students: * Administration of such test shall be
                                         required prior to student's first assignment at PROVIDER.If a
                                         student maintains continuous enrollment at SCHOOL and
                                         participates in a subsequent rotation at PROVIDER, and
                                         SCHOOL provides a written statement to PROVIDER prior
                                         to such subsequent rotation that it has no reason to
                                         believe that the student has not continued to be drug- free,
                                         safe and qualified for the clinical experience under this
                                         Agreement, then such test will not be required for the
                                         subsequent rotation. If no such statement is provided by
                                         SCHOOL, such test will be required prior to the subsequent
                                         rotation.

                                         Health Requirements: No active Tuberculosis, as evidenced
                                         by two tuberculin skin tests showing either (a) a negative result,
                                         (demonstrated by either the last two consecutive annual TB
                                         skin tests dated within two (2) years of the date of assignment
                                         at St. Luke's OR two step TB testing - two tests dated within
                                         one (l) year of date of assignment at St. Luke's) or (b) if a
                                         positive result, additional completion of a TB symptom
                                         questionnaire AND negative chest x-ray or BAMT
                                         Blood Assay Mycobacterium Tuberculosis test done no earlier
                                         than three (3) years prior to the date of assignment at the
                                         PROVIDER. History of BCG administration without TB testing
                                         is NOT acceptable.
Samaritan Health Services, Inc.
Corvallis, Oregon
Sanford Health                           Students must review and complete the Sanford Health Orient
                                         ation Packet, please note the directions for sending the forms.
Sioux Falls, South Dakota                They can be faxed to 605-312-9837 or scanned/emailed to:
                                         STUDENTSSF@SanfordHealth.org
                                         Faculty must complete the Faculty Verification form and
                                         provide objectives and the final preceptor evaluation form no
                                         later than 2 weeks before clinical experience begins. Please
                                         ask contract office for info sheet from Sanford.
Santa Rosa Public Health Department
Milton, Florida
Saraland City School System
Saraland, Alabama
Scott Memorial Hospital
Scottsburg, Indiana
Searcy Hospital
                          UNIVERSITY OF SOUTH ALABAMA
                                COLLEGE OF NURSING
                                 September 20, 2012
                      Clinical Agency Affiliations and Locations
                Agency Name                              Agency Requirements
Mt. Vernon, Alabama (renewing)
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
Memorial Hospital)
Chesapeake, Virginia
Seton Healthcare d/b/a Seton Healthcare
Network, Austin, Texas (to include but not
limited to Seton Medical Center Austin,
Seton Northwest Hospital, University
Medical Center at Brackenridge Hospital,
Seton Shoal Creek Hospital, Seton Edgar B.
Davis Hospital, Dell Children’s Medical
Center, Seton Southwest Hospital, Seton
Medical Center Williamson, Round Rock,
Seton Medical Center Hays.


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

Sharp HealthCare                                      *Nursing Informatics ONLY*
                                                      Faculty: must contact Claudia Bock at 858-499-5366
San Diego, California                                 or by email at claudia.bock@sharp.com to fill out a
                                                      roster of students being placed at Sharp. Faculty
                                                      who will be on site with students need to contact
                                                      Barbara DeFulvio at 585-499-5244 or
                                                      Barbara.Defulvio@sharp.com. Faculty web site is
                                                      www.sharp.com/b2b/students.index.cfm
                                                      Faculty must read Exhibit A, please ask for in the
                                                      contracts office.

                                                      Students: need to access the following web site
                                                      www.sharp.com/b2b/students.cfm.
                              UNIVERSITY OF SOUTH ALABAMA
                                      COLLEGE OF NURSING
                                        September 20, 2012
                         Clinical Agency Affiliations and Locations
                Agency Name                                        Agency Requirements
                                                  Faculty must submit Letter of Understanding to Memorial for
Sheridan Children’s Healthcare Services and each student. Student may be required to purchase general
South Broward Hospital District d/b/a Memorial    liability insurance if applicable.
Healthcare System (Memorial includes: Memorial
Regional, Memorial Regional Hospital South, Joe
DiMaggio Children’s Hospital, Memorial Hospital
Pembroke, Memorial Hospital West, Memorial Hospital
Miramar)
Hollywood, Florida

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

Spokane, Washington
Sharp HealthCare                                          Faculty: must contact Claudia Bock at 858-499-5366 or by
                                                          email at claudia.bock@sharp.com to fill out a roster of students
San Diego, California                                     being placed at Sharp. Faculty who will be on site with students
                                                          need to contact Barbara DeFulvio at 585-499-5244 or
                                                          Barbara.Defulvio@sharp.com. Faculty web site is
                                                          www.sharp.com/b2b/students.index.cfm

                                                          Students: need to access the following web site
                                                          www.sharp.com/b2b/students.cfm.

                                                          To make sure that the students background checks and drug
                                                          screening requirements are complete, please see Attachment
                                                          A.
Success Healthcare d/b/a Silver Lake Medical
Center
Los Angeles, California
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 Baldwin Regional Medical Center                     Student must provide written evidence of negative TB test
                                                          within the past year or chest x-ray within last 3 years, written
Foley, Alabama                                            documentation of a completed Hepatitis B vaccine or one has
                                                          begun the series.
South Broward Hospital District d/b/a                     Masters in Nursing Program, Neonatal NP

Memorial Healthcare System
Hollywood, Florida
South Carolina Dept. Health and                           Students must sign Attachment 1

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
                          UNIVERSITY OF SOUTH ALABAMA
                                 COLLEGE OF NURSING
                                  September 20, 2012
                      Clinical Agency Affiliations and Locations
                Agency Name                                   Agency Requirements
Laurel, Mississippi                           prior to starting

Southcoast Hospitals Group, Inc.              Students and on-site instructors must complete 10 panel urine
                                              drug test prior to beginning clinicals. Students must complete
New Bedford, Massachusetts                    the student/Instructor Confidentiality Agreement.
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
Vidalia, Georgia
South Mississippi Home Health, Inc.
Hattiesburg, Mississippi
Southwest Mississippi Regional Medical
Center
McComb, Mississippi
Springhill Memorial Hospital
Mobile, Alabama (renewing)
St. Alphonsus Physicians Services, Inc.       Students must complete Attachments prior to starting
                                              clinicals—See faculty
Boise, Idaho (renewing)
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.              Attachment 1,2 and 3
                                              Exhibit A RN-BSN program
Monroe, Louisiana (renewing)                  Exhibit B MSN program
                                                         Exhibit C DNP program
St. Francis Hospital, Inc.                               Students must complete Exhibits A & B prior to beginning
                                                         clinicals
Columbus, Georgia (renewing)
St. John Medical Center, Inc.
Tulsa, Oklahoma

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. Luke’s Behavioral Health Center                      Confidentiality form, HIPPA form, supervising Physician
                                                         agreement. (Directions available) Students must submit
Phoenix, Arizona (renewing)                              these forms 14 days prior to beginning clinicals.
St. Luke’s Health System, Ltd. (to include               Students must complete Attachment A. Agreement is specific
                                                         to Nurse Practitioners.
                          UNIVERSITY OF SOUTH ALABAMA
                                 COLLEGE OF NURSING
                                  September 20, 2012
                       Clinical Agency Affiliations and Locations
                Agency Name                               Agency Requirements
St. Luke’s Regional Medical Center –Boise
& Meridian, St. Luke’s Eagle Medical Plaza,
and St. Luke’s Clinics
Boise, Idaho
St. Luke’s Northland Hospital
Kansas City, Missouri
St. Mary’s Health System (now owned by Mercy Student must have 30 day advance approval from agency.
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
Survivors of Mental Illness (SOMI)
Mobile, Alabma
Sutter General Hospital
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               Contract only to be used as a 3-way
Science Center) (including Florida Gulf to Bay       agreement with Tampa General/Gulf to
Anesthesiology Associates, PA)                       Bay/University of South Alabama
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
                         UNIVERSITY OF SOUTH ALABAMA
                                COLLEGE OF NURSING
                                  September 20, 2012
                      Clinical Agency Affiliations and Locations
               Agency Name                                  Agency Requirements
Center, Paul L. Foster School of Medicine,    students beginning clinicals. Faculty please contact Alicia
                                              Gacharna at (915) 545-6921 for forms.
Department of Pediatrics
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)
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
UMASS Memorial Medical Center, Inc.                      USA Faculty must provide UMMMC with a Program schedule
                                                         of clinical days and dates as well as the number and names of
Worchester, MA                                           Students and Faculty to be assigned to the Program. This must
                                                         be submitted at least two weeks prior to the start of the relevant
                                                         Program period. Students must complete Orientation forms
                                                         prior to beginning clinicals.
                         UNIVERSITY OF SOUTH ALABAMA
                                COLLEGE OF NURSING
                                 September 20, 2012
                     Clinical Agency Affiliations and Locations
               Agency Name                                  Agency Requirements
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

(renewing)
Tucson, Arizona
University of Colorado Hospital (renewing)             Student must fulfill what is outlined in Attachment A prior to
                                                       beginning clinicals
Aurora, Colorado
University of Chicago Medical Center                   Faculty must provide a written description of the program and
                                                       objectives of the courses and the approximate number of
Chicago, Illinois                                      students to be assigned at any given time in the units. The
                                                       names of the students shall be submitted three weeks prior to
                                                       the beginning of the semester. USA must provide the names
                                                       and credentials of the faculty who will participate in the
                                                       Program activities.
University of Florida, College of Medicine,
OBGYN Department
Pensacola, Florida
University of Florida, College of Medicine             Students must complete Exhibit A prior to beginning clinicals.
                                                       This includes a 12 panel drug screen.
Jacksonville, Florida
University Health System, Inc.                         Student must complete Exhibits A & B and Attachment 1 prior
                                                       to beginning clinicals
Knoxville, Tennessee
University of Kentucky Medical Center
Lexington, Kentucky
University of Maryland Medical Center                  Student must complete Attachment A prior to beginning
                                                       clinicals.
Baltimore, Maryland
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 of Michigan Health System
                           UNIVERSITY OF SOUTH ALABAMA
                                 COLLEGE OF NURSING
                                   September 20, 2012
                       Clinical Agency Affiliations and Locations
                Agency Name                                   Agency Requirements
Ann Arbor, Michigan
University of Minnesota Physicians
Minneapolis, Minnesota
University of Mississippi Medical Center       Students must complete Epic System Training. Visit
                                               affiliated student webpage www.umc.edu, then click on
Jackson, Mississippi                           Education tab, then affiliated students under Resources.
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 North Carolina Hospital (UNC              Faculty must provide number of student(s), course objectives,
                                                        and responsible faculty member from USA to UNC’s program
Hospital)                                               coordinator. Faculty and Student please read Appendix A.
Chapel Hill, North Carolina                             Students must read and sign Appendix B and C prior to
                                                        beginning clinicals. 12 panel drug screen required.
University of Oklahoma, School of                       Student must sign Affiliation Confidentiality Agreement prior to
                                                        beginning clinicals.
Community Medicine
Tulsa, Oklahoma
University of South Alabama Hospitals                   Faculty please request attachments for: Instruction email,
                                                        Scope of Physician Participation, and Implementation of eCare.
Mobile, Alabama
USA Mitchell Cancer Institute
Mobile, Alabama
University of South Carolina
Columbia, South Carolina
University of Utah Hospitals and Clinics                The student needs to purchase their own general
                                                        liability insurance with the amounts being
Salt Lake City, Utah                                    $1000,000/$3,000,000. Also, the student will be
                                                        responsible for health insurance/ or worker's
                                                        compensation.

                                                        Faculty: At least four weeks prior to the beginning date
                                                        the agency must be sent the name of each student and
                                                        the program description to the University of Utah
                                                        Hospitals and Clinics.

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 (renewing)
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.
                         UNIVERSITY OF SOUTH ALABAMA
                                COLLEGE OF NURSING
                                   September 20, 2012
                      Clinical Agency Affiliations and Locations
              Agency Name                                     Agency Requirements
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
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
                          UNIVERSITY OF SOUTH ALABAMA
                                COLLEGE OF NURSING
                                  September 20, 2012
                      Clinical Agency Affiliations and Locations
               Agency Name                                  Agency Requirements
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 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
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
VA Medical Center (Wm. Jennings Dorn)         Faculty-Educational Institution Verification Letter must be
                                              signed and sent from Dr. Rhodes.
Columbia, South Carolina
Veterans Affairs North Texas Medical          Advanced Geropsych Assessment Older Adults Practicum RN-
                                              BSN-MSN
                        UNIVERSITY OF SOUTH ALABAMA
                               COLLEGE OF NURSING
                                September 20, 2012
                     Clinical Agency Affiliations and Locations
                Agency Name                          Agency Requirements
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
VA Stars and Stripes Healthcare Network
Lebanon, Pennsylvania
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
Virginia Department of Health (Prince            Faculty must notify Department at least 60 days in advance:
                                                 number of students and beginning and ending dates for
William Health District, Portsmouth              clinicals. Submit in writing to the Department at least 30 days in
Department of Health)                            advance of mutually agreed upon planned experience.
                                                 Student will maintain $2,000,000 in general liability
Richmond, Virginia                               coverage and provide evidence of said coverage.


Wake Forest University Baptist Medical           For Clinical Faculty and Students additional on-site
                                                 requirements may include participating in orientation, on
Center (North Carolina Baptist Hospital)         site HIPAA and other training, submission to a TB test,
Winston-Salem, North Carolina                    submission of a criminal background check, a 10 panel
                                                 drug screen, and proof of a seasonal flu vaccine.
Walton County Health Department
Defuniak Springs, Florida
WellStar Health System, Inc. (to include:        Only WellStar employees are eligible. Students must complete
                                                 an orientation packet prior to beginning any clinical rotation.
Cobb, Kennestone, Paulding, Douglas, and Windy
Hill)
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
                         UNIVERSITY OF SOUTH ALABAMA
                                COLLEGE OF NURSING
                                 September 20, 2012
                      Clinical Agency Affiliations and Locations
              Agency Name                             Agency Requirements
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


William S. Middleton Memorial Veteran’s
Hospital
Madison, Wisconsin
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.
Women & Infants Hospital
Providence, Rhode Island
Zablocki VA Medical Center
Milwaukee, Wisconsin

				
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