NOTE: Existing Students who have filled out this application before, please click here to login to the Allegheny Health Network Volunteer Portal to fill out your form.

Before beginning this application you must have the following information and documents ready to upload:
  • TB Test Results: Tuberculin status (PPD) documented within the last 12 months. (If positive results - must provide copy of radiology report and doctor's letter).
  • Email confirmation from AHN Employee you are shadowing: Confirmation must include date and time of the experience that matches the application request
  • Name of person that applicant will shadow: Include mentor's email and phone number
  • Date/s of experience: Date/s must be specific.  Date ranges, TBD, ANY responses are not acceptable
  • Start and end time of experience: Time that you will be on site. Example 9am-12pm
  • Number of total hours you will shadow: Maximum 16 hours per calander year
  • Where applicant is to report for shadowing experience: Hospital/Site location and department name

Applications must be submitted 10 business days prior to the experience date.

Applicant Information
Thank you for your interest, however minimum requirement of age to submit this application is 16 or 17 years of age.
Proof of Immunity

Have you had the following childhood diseases?

Have you been immunized for each of the following?

Emergency Contact Information
Alternate Emergency Contact

Conditions of Participation Agreement

I desire to gain experience in the field of medicine by job shadowing an AHN Employee health care worker within Allegheny Health Network.
I understand that this healthcare facility is willing to avail its premises to me for the sole purpose of  shadowing its healthcare workers so long as I agree to adhere to the conditions set forth below:

  • The healthcare facility shall retain ultimate responsibility for all patient care activities. I shall not, at any time, touch a patient or be directly involved in the provision of patient care.  
  • The health care facility reserves the right, at any time, to discontinue this job shadow experience, on a temporary or permanent, basis, for any reason.
  • The healthcare facility makes no representation or warranty concerning the quality of this job shadow expereince, nor does it make any representation or warranty concerning whether it will suitably prepare me for future medical practice in any capacity or position.
  • Prior to my start date as a job shadower, I shall submit documentation of tuberculosis screening (PPD), no older than 12 months.
  • The healthcare facility will adhere strictly to the above-listed health requirements and documentation thereof. Therefore, I understand that I will not be permitted to begin shadowng at the facility without fulfilling the same.
  • The healthcare facility will adhere strictly to the practice of Universal/Standard Precautions as outlined in the facility's policy of the same name, in order to avoid any contact with blood, body fluids, or potentially infectious materials.
  • In the event of an exposure or personal injury, it will be my responsibility to:
    • Report the exposure to the individual you are job shadowing.  
    • Report immediately to an emergency department in the AHN system, after the exposure, but in no event later than the day following the exposure. This is mandatory to confirm a significant exposure or the severity of this injury and to initiate any necessary therapy and/or treatment.
    • All emergency first aid rendered in case of an accident or sudden illness and/or all exposures will be treated at the job shadower's expense. Any required follow-up treatment, testing or counseling will be conducted by my personal physician and not by the healthcare facility.

HIPAA (Health Insurance Portability & Accountability Act)
HIPAA is a federal law.
Protected health information (PHI) includes:

  • Biometric identifiers  
  • Social Security Numbers  
  • Medical record numbers or account numbers  
  • Photographs  
  • Auto license numbers/VIN numbers  
  • URLs/IP (Internet) addresses  
  • Health plan beneficiary numbers  

Your role in HIPAA:

  • Keep patient-specific information out of public view  
  • Conduct conversations regarding patients in areas where others cannot overhear information. Do not discuss patient
    information in public areas.
  • Limit access to patient health care information to those who need to know it to do their job.  
  • Patient charts or medical records should be kept in a location that is monitored by staff 100% of the time or
    locked to secure the information.
  • Discard all confidential patient information such as admissions reports or surgery schedules in a designated
    shredder bin.

Tobacco Use:  

All AHN campuses are tobacco free and prohibit the use of tobacco products on or adjacent to our property. This
includes cigarettes, e-cigarettes, cigars, chewing tobacco, clove cigarettes and vaping. Everyone is responsible
for adhering to this policy.  

Dress Code: 

As a participant in the AHN Job Shadow Experience at AHN, you are expected to maintain a neat, well-groomed and professional appearance at all times.  

  • Hosiery or socks are required  
  • Khaki pants or dress pants are appropriate  
  • No jeans, spandex, yoga pants or shorts  
  • No open-toed shoes  
  • Dress or tennis shoes are appropriate  
  • Any type of jewelry is permitted that does not impair the ability to perform the assigned task or present a hazard

Personal Grooming and Hygiene:  

  • Men must be clean shaven or have well-groomed beards and mustaches  
  • Perfumes, colognes, and scented products are not to be worn in patient care areas  
  • Practice good hygiene  
  • Hairstyles must be neat and well groomed  
  • Tattoos are permissible if the words, symbol, or images are not offensive or contrary to AHN mission and core
    values

Fingernails:  

To decrease the risk of hospital acquired infections:

  • Fingernails must appear clean and well-manicured  

These guidelines coincide with the AHN employee dress code. The hospital reserves the right to deny the job shadow experience
 if these guidelines are not followed.

Rules of Conduct

A job shadower is expected to follow the general Rules of Conduct as described in the AHN Policy. This policy prohibits, but is not limited to:

  • Damage to hospital equipment, property, etc.
  • Insubordinate behavior
  • Theft
  • Possession of firearms or explosives on Hospital premises
  • Recklessness
  • Incidents affecting the goodwill and reputation of the Hospital

 

Confidentiality

All job shadowers must hold absolutely confidential all information obtained either directly or indirectly concerning the Hospital, its patients, doctors, personnel or volunteers.

All information heard while on duty is confidential and may not be discussed with anyone. This includes the NAMES of our patients and their illnesses.

A breach of confidentiality can result in dismissal from the Job Shadow Day experience. Intentional disclosure of confidential health information can result in fines and imprisonment of up to one year-or both.


All job shadowers must sign the "Conditions of Participation Agreement" and, "Observation Day Confidentiality Agreement" to indicate their understanding of the confidentiality policy.

Respecting Others

As a partipant in the AHN job shadow experience, it is important to be aware and respectful of the cultural heritage of all patients and staff. There are people of all ages at the hospital who have different racial heritages, ethnic backgrounds, genders and religions. Being culturally sensitive means accepting that other's thoughts, behaviors and experiences may be different than yours. Everyone deserves to be treated with respect, consideration and dignity at AHN.

Social Media Policy Part 1

Personal Use And Business Use Of Social Media By AHN Employees


Policy Scope:

This policy applies to the AHN entities and individuals outlined in the policy applicability section below.


Policy Statement:

A. This policy covers the use of social media by Allegheny Health Network (AHN) employees under these circumstances:

1. Employees' business use of social media websites as part of their job responsibilities;

2. Employees' personal use of social media as it relates to AHN and its employees.

B. Regarding AHN's use of social media:

1. Only authorized employees will represent AHN on social media websites, which AHN uses for outreach activities that include but are not limited to: advertising and marketing; news media and community relations; community health education; recruiting employees; patient education and relations; news announcements about organizational changes, medical research and breakthroughs; new medical practices and office locations; public events; information on health care reform, insurance choice and affordability; information about Medicare, Medicaid, etc.

C. Regarding employees' personal use of social media websites:

1. AHN respects the right of employees to participate in online social media communications and networking. However, employees' personal use of social media creates responsibilities employees must recognize and follow, including the knowledge they cannot share Protected Health Information (PHI), even if not using the name of a patient. In postings reflecting on or mentioning AHN, employees must always make clear their opinions are their own and not those of AHN. AHN reserves the right to monitor employees' social media accounts for violations of this policy.


Policy Purpose:

A. To ensure the privacy and confidentiality of AHN patients and follow all requirements of the Health Insurance Portability and Accountability Act; the Patient Protection and Affordable Care Act; the Health Care and Education Reconciliation Act.

B. To define who can use social media websites for AHN outreach communications, and what information they can put on those websites.

C. To protect the reputation and standing of AHN and its employees.

D. To educate AHN employees when they can access their personal social media websites, and how they must protect patient information and not violate AHN policies when using personal social media websites.

E. To inform AHN employees of consequences of violating this policy.

Social Media Policy Part 2

Policy Purpose:

A. To ensure the privacy and confidentiality of AHN patients and follow all requirements of the Health Insurance Portability and Accountability Act; the Patient Protection and Affordable Care Act; the Health Care and Education Reconciliation Act.

B. To define who can use social media websites for AHN outreach communications, and what information they can put on those websites.

C. To protect the reputation and standing of AHN and its employees.

D. To educate AHN employees when they can access their personal social media websites, and how they must protect patient information and not violate AHN policies when using personal social media websites.

E. To inform AHN employees of consequences of violating this policy.

Policy Definitions:

A. Social media: Widely accessible electronic and online tools and services people use to connect with one another and to publish and access information, collaborate on a common effort or build relationships. Social media include but are not limited to five main categories:

1. Social networking, such as Facebook, Google+, Instagram, LinkedIn, Pinterest, Tumblr, Twitter, Vine and others, which allow people to interact by adding friends and associates, commenting on profiles, joining groups and having discussions.

2. Social photo and video sharing, such as YouTube, Flickr and others, which allow people to interact by sharing photos or videos and commenting on user submissions.

3. Social news, such as Digg, Propeller, Reddit and others, which allow people to search for articles and comment on them.

4. Social bookmarking, such as Del.icio.us, Blinklist, Simpy and others, which allow people to interact by tagging websites and searching through websites bookmarked by other people.

5. Wikis, such as Wikipedia, Wikia and others, which allow people to interact by adding articles and editing existing articles.

B. Information: Knowledge of specific events or situations gathered or received by communication.

C. Protected Health Information (PHI): Information about a patient's health status or about providing health care to a patient, including past, present or future payment for health care services. PHI also includes direct or overheard conversations among caregivers, patients and family members.

D. Employee: When this policy states the word "employee" that word is defined as "employee and affiliate ".

E. Affiliate: This policy applies to people who are affiliates of AHN, defined as follows for the purpose of this policy: residents and fellows; independent credentialed/privileged providers, including physicians, nurse practitioners, physician assistants, certified registered nurse anesthetists and midwives; contracted/embedded workforce; independent consultants; volunteers; students.

F. Authorized employee: These are AHN employees the Department of Marketing and Communications assigns or authorizes, as part of their job duties, to post information about AHN on social media websites.

 

Social Media Policy Part 3

Guidelines/Procedures:

A. The Vice President of Internal and External Communications is responsible for ensuring only authorized employees use social media websites for AHN business communications, and that these employees follow procedures in this policy. The vice president is also responsible to answer and provide guidance on specific questions about this policy.

B. The Marketing and Communications Department is in charge of all AHN social media communications, including information generated outside the Department that is used for AHN outreach communications.

C. The Human Resources Department is in charge of investigating violations of this policy in regard to employees' personal use of social media. Human Resources is also in charge of corrective action involving employees who violate the personal use portion of this policy.

D. Use of social media for AHN business purposes:

1.Employees who are authorized to use social media for AHN business and medical reasons cannot delegate their posting responsibilities to others unless directed to do so by the Vice President of Internal and External Communications.

2. Employees cannot post content that is Protected Health Information (PHI).

3. As in all AHN internal and external communications, authorized users will strive for accuracy and professionalism in everything they post. The same editorial rules that apply to AHN internal and external communications apply to communications via social networking.

4. If an employee, group of employees or affiliates outside the Department of Marketing and Communications believes it has an idea for a social media outreach effort that will be important and beneficial to AHN and the communities it serves, the employee, employees and/or the affiliates will contact the Vice President of Internal and External Communications first, for discussion and approval.

E. Employees' personal use of social media:

1. By using AHN computers, individuals consent to have any communications made through them monitored, recorded and otherwise assessed.

2. Employees cannot access their personal social media websites while working (except on breaks) and cannot use AHN computers and other devices to access personal social media websites.

3. When setting up a social networking account, employees must use their personal e-mail address and URL, not their individual AHN-provided e-mail or URL, if they have one.

4. Employees who express personal views on social media websites about AHN or AHN-related activities and medical/health/business interests must clearly state the views are their own and not the position of AHN.

5. Employees must understand and know what is Protected Health Information as defined in "Policy Definitions" Item C above, and expanded in Appendix A.

6. Employees cannot use AHN logos, graphics, photographs and other artwork on personal social media websites.

7. Employees cannot link from their personal social media websites to official AHN websites.

8. All other organization rules and policies regarding disclosure of sensitive, proprietary, protected health information or confidential information apply in full to personal blogs, web pages and social media networking activity. If an employee has questions about whether information is approved for public dissemination, the employee must contact the Vice President of Internal and External Communications for guidance.

Social Media Part 4

Guidelines/Procedures (continued)

E. Employees' personal use of social media:(continued)

9. While AHN recognizes the right of employees to engage in dialogue and provide information on social media websites about day-to-day issues they face and other personal information that might relate to their jobs and job responsibilities, all employees must refrain from posting information about AHN or their jobs that could detrimentally affect AHN's reputation, violate its policies, or might embarrass or offend coworkers, patients or other constituents of AHN. Employees must use common sense and good judgment, recognizing information they publish online becomes immediately searchable, can be immediately shared and will have a long presence on the Internet.

See Appendix A for questions employees should ask themselves if they plan on posting AHN-related information on a personal social media website.

10. Employees cannot take information from AHN websites, printed material and other communications and use it as their own on their personal social media websites.

11. AHN reserves the right to monitor employee's social media websites to protect AHN's interests and to monitor employees' compliance with this policy. If AHN finds activity that is compromising, insubordinate or averse to AHN interests, AHN reserves the right to require the employee to cease such activities and remove detrimental commentary or postings.

12. AHN may discipline employees for posting unprotected, inappropriate commentary, content or images that are or may be considered defamatory, pornographic, harassing, threatening, libelous, hostile to a work environment or in violation of this policy or other AHN policies.

13. Employees who violate this policy will be subject to disciplinary procedures.

14. If when using social media, an employee should contact the media or be contacted by the media regarding AHN, the employee must immediately refer the contact to the vice president of Internal and External Communications for coordination and guidance. Individuals must understand that any statement they might make to the news media via online social networking may be considered on-the-record and could be published, re-posted and quoted in electronic broadcasts.

15. If an AHN employee discovers a blog or other online communication by another employee that appears to violate this policy, the individual should immediately report the site to Human Resources. Human Resources will promptly investigate all such matters and determine whether the posting violates any policy and take appropriate action.

16. When information considered to be inappropriate or in violation of this policy is brought to a manager's attention, the manager should report the information to Human Resources. Because it is not Allegheny Health Network's intention to regulate protected conduct, managers must consult and work in conjunction with Human Resources before taking any adverse action, including, but not limited to requesting an employee remove a posting, coaching/counseling an employee verbally or in writing regarding a posting, or issuing other discipline.

17. Retaliation against individuals who bring forth any violations in good faith under this policy is prohibited. Retaliation against any individual who is a witness in an investigation also is prohibited.

18. The Vice President of Internal and External Communications is responsible for managing official AHN social media communications. Unless authorized by the Department of Marketing and Communications, employees are strictly prohibited from acting on behalf of AHN through social media sites that feature pictures, programs, services, staff or patients of AHN. All such requests for social media marketing support should be directed to the Vice President of Internal and External Communications.

19. Employees are required to comply with this policy and cooperate with investigations of the employee's use of social media as it relates to AHN.

Attestation and Acknowledgement:
Personal and Business Use of Social Media Policy

I have carefully read, understand, and will strictly abide by the 'Personal and Business Use of Social Media Policy', and know where to locate this policy for reference.

I will not disclose Protected Health Information (PHI) belonging to our patients on any social media platform or in any public forum, even if that information is publicly available.

Confidentiality Statement

  • I understand and agree that all information that I encounter during my job shadow experience at AHN will remain strictly confidential.  
  • I understand that the principles of confidentiality are applicable to all patients and to all medical record information regardless of the format or technology used to collect, store or release the information. I also understand that all verbal, written or electronic collection and dissemination of patient data will be conducted in a setting of maximum privacy precluding inadvertent disclosure.
  • I agree not to disclose any information that I may acquire during my job shadow experience at AHN unless previously authorized in writing by the hospital. Further, I agree that I will not use confidential information to my benefit or the benefit of any third party.
  • In addition to the confidentiality principles described above, I recognize that I am not an employee or agent of AHN and I will not represent myself as such during my job shadow experience at the hospital. I will not undertake any actions independently during my job shadowing experience.
  • I recognize that AHN has rules of conduct, behavior and personal health standards and I will be expected to conform to those rules that apply to my job shadow expereince day.
  • I further understand that I will forfeit completion of the job shadow experience day if confidentiality is breached.

Minor Age AHN Job Shadow Expereience Parental Consent Form
All Job Shadow Applicants must be in good health and must attest immunity to Mumps, Rubella (German Measles), Rubeola (Measles), and Varicella (Chicken Pox) either by vaccination (often listed as MMR on vaccination record) or having been diagnosed with the disease. You and your child must attest yes/no to your child having the above childhood diseases and/or being immunized for each on the Job Shadow Application.

A negative result within one year Tuberculin (TB) test is mandatory to participate in the AHN Job Shadow Experience. TB testing can be either QuantiFERON-TB Gold (QFT) or TB skin test (PPD). Cost of the TB test is the responsibility of the Job Shadow applicant. If your child is unable to get a TB test then a chest X-Ray is required along with physician acknowledgement that there is no evidence of disease.


Parental Consent
By my signature below, I give permission for my daughter/son to participate in the Allegheny Health Network Job Shadow Experience
I understand that the AHN Job Shadow experiences are classified as an experience that is 16 hours or less in a calendar year this is purely a shadowing experience, and is not hands-on learning. I understand that my daughter/son will receive no monetary payment as a minor age participant in this experience.

I understand the job shadow expereince will give my child the opportunity to observe an AHN employee performing his/her daily duties at the AHN location and department/unit they requested to shadow on the application.

I understand the health requirements for my daughter/son to participate in the AHN Job Shadow Experience.

I hereby release AHN and any employees thereof from all damages which I, my child, my executors, administrators, or assigns, incur during such activities.

Applicant signature indicates understanding and acceptance of the contents of this packet.