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Short-term observers are appointed by Trainee & Alumni Affairs. This form must be
completed and returned to Trainee & Alumni Affairs (Unit 165) 30 days prior to the first
day of the appointment.
Short-term observers are academicians and educational trainees who come to this
institution for 30 days or less in a 12-month period.
Short-term observers may attend conferences and lectures. Those who are physicians
or dentists may also observe clinics, the operating room and rounds in accordance with
appropriate medical staff policy.
Short-term observers are not provided a stipend. Housing, health insurance, and living
expenses are the responsibility of the short-term observer.
Short-term observers must complete the HIPAA privacy test for direct care providers.
Non-U.S. citizens are required to check in with the Office of International Affairs (OIA)
before the first day of the appointment. OIA is located at 7000 Fannin, Suite130,
Houston, TX 77030. Non-U.S. citizens should bring all original immigration documents.
All short-term observers are required to check in with Trainee & Alumni Affairs (TAA) prior
to the first day of the appointment. Non-U.S. citizens must present their clearance form
from OIA. U.S. citizens must present picture identification.
Revised 08/13/2007
Application for Short-Term Observer Appointment
Visa Type (choose one): B1/B2 F-1 F-2 J-1 J-2 VWP Other: _____________
Briefly state your goals and objectives in coming to M. D. Anderson Cancer Center as a short-term observer.
What do you hope to learn? What outcomes do you expect to achieve? How will you measure those
outcomes? Please be specific. (Attach a separate sheet if you prefer.)
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Your activities at this institution are governed by The UT System Rules and Regulations, including the institutional
Intellectual Property Policy (Policy IV.J.3.01). You will be expected to maintain the confidentiality of University
proprietary information, and to obtain approval from your chair/mentor/program director prior to disclosing or
publishing any results of your activities at M. D. Anderson.
You may come into contact with health information while you are a short-term observer at M. D. Anderson. All
health information is regarded as confidential and made available only to authorized individuals or as required
by law. Release of any individually identifiable medical information for any purpose other than direct patient
care, or research that ensures anonymity, must be done only with authorization of the patient or the patient's
authorized agent.
Applicant’s signature acknowledges that regulations concerning short-term observers have been read and
understood, and that the information provided is complete, accurate, and not misleading to the best of his or
her knowledge.
Signature of Department Chair, Deputy Department Chair, or Responsible Faculty Please Print Name
Approved Disapproved
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HIPAA Privacy Training
Please refer to the HIPAA Privacy Booklet (pdf file) to complete the final exam below. Click on the correct
answer.
4. What kind of protected health information is protected by the HIPAA privacy rule?
a. Paper
b. Electronic
c. The spoken word
d. All of the above
5. True or False? Your organization must make any amendments to records that patients request.
a. True
b. False
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8. Which of the following are some common features designed to protect the confidentiality of health
information contained in patient medical records?
a. Password protection
b. Locks on medical records files or file room
c. Rules that prohibit employees from looking at records without a need to know the information for
their jobs
d. All of the above
10. You are on duty elsewhere in the hospital when you hear that a neighbor has just arrived in the EC for
treatment. You should:
a. Contact the neighbor’s spouse to alert them
b. Do nothing
c. Tell the charge nurse in the EC that you know how to reach the patient’s spouse if the
information is needed.
11. True or False: Confidentiality protections cover not just a patient’s health related information, such as
their diagnosis, but also other identifying information such as Social Security numbers and telephone
numbers.
a. True
b. False
12. If you suspect someone is violating the institution’s privacy policy, you should:
a. Confront the individual involved and remind him or her of the rules
b. Watch the individual involved until you have gathered evidence against him or her
c. Report your suspicions to the institution’s Compliance Officer, as outlined in your policy
13. True of False: Computer equipment that has been used to store patient health information must
undergo special processing to remove all traces of information before it can be disposed of.
a. True
b. False
14. When disclosing patient information to another provider for the provision of treatment, should you limit
the patient information you provide?
a. No, you should provide all patient information, including the entire medical record
b. Yes, you should provide only the minimum amount of information necessary for treatment
c. Strictly speaking, you don’t have to limit information for treatment under HIPAA. However, good
practices and most policies say to consider what’s being asked for. For instance, don’t send the
whole medical record if only the current medical problem is involved.
To ensure that you receive credit for completion of HIPAA Privacy training, submit your answer sheet with your
application for short-term observer.
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Tuberculosis Screening
Tuberculin skin test (PPD) is required within the last 12 months, even if you have received BCG vaccination,
unless documentation is submitted of a past positive PPD (10 mm or more induration.)
Chest x-ray findings if PPD is positive, completed after positive skin test.
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