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Pre-professional application

If you are interested in seeking observation-only hours at Mercy Regional Health Center, you can submit a pre-professional application. Students can observe as a pre-professional up to 20 hours in various areas of the hospital.

General information
(Include area code, no dashes)
School requirement
Vaccination requirements
To complete the pre-professional application, you must provide: Documentation of two (2) MMR (measles, mumps, and rubella) or established immunity and two (2) Varicella (Chicken Pox) vaccinations or evidence of immunity, along with a current TB (Tuberculosis) test result within the past year and the current year’s influenza vaccination.

It is required that you submit your vaccination documents within five business days for your application to be processed

Please mail your records to the address below, fax it to 785-587-5416 or email to crystal_bryant-kearns@mercyregional.org.  

Mercy Regional Health Center
Volunteer Services
1823 College Avenue
Manhattan, KS 66502

Employment and education
Below, please provide applicable information regarding employment and/or student status.
Confidentiality agreement
Mercy Regional Health Center recognizes the importance of protection of confidential information concerning patients, their families, medical staff and co-workers and the operations of the hospital. It is the intent of Mercy Regional Health Center and the undersigned to protect the privacy and provide for the security of Protected Health Information (PHI) disclosed to the undersigned in compliance with the Health Insurance Portability and Accountability Act of 1996 (HIPAA) and privacy regulations published by the U. S. Department of Health and Human (DHHS) and other applicable laws. It is the obligation of the undersigned to maintain the confidentiality and privacy of PHI or other confidential information and to relay facts pertinent to the treatment of a patient only to those who are involved with the patient’s treatment program or for quality improvement activities. All patient and health center information including protected health information in any form (oral, written, or electronic) is considered confidential. Computer systems allow qualified individuals to access, from authorized terminals, restricted and confidential patient and hospital information. The hospital shall issue a confidential password and security code to authorized individuals. It is the authorized individual’s ethical and legal responsibility to maintain and comply with all the confidentially requirements. Mercy Regional Health Center requires that all agree to the following: 1. I will protect the confidentiality of patients and health center information 2. I will not release protected health information or other confidential information to any source unless authorized 3. I will not access or attempt to access information other than necessary information which I have been authorized to access 4. I will not use another person’s security code 5. I will not write down passwords or security codes that would make them accessible to other individuals 6. I will report breeches of this confidentiality agreement by others to the Mercy Regional Health Center privacy office. I understand that failure to report breeches is an ethical violation which will subject me to civil and/or criminal penalties Please Read the Following Carefully and Sign Below I certify, to the best of my knowledge, that all information given by me in this application is true and correct. I authorize Mercy Regional Health Center to utilize this information in determining my pre-professional placement. I understand that false or misleading statements made by me or consequential omissions of any kind in the application process are sufficient causes for my not being accepted as a pre-professional or for my dismissal from the Mercy Pre-Professional Program. I understand that I will not be paid for my services as a Pre-Professional. I HAVE READ AND AGREE TO ADHERE TO THE CONDITIONS OF THIS CONFIDENTIALITY AGREEMENT. I ACKNOWLEDGE THAT ANY VIOLATION OF THE ABOVE CONDITIONS CAN RESULT IN DISCIPLINARY ACTION OR CONTRACT TERMINATION, SEVERENCE OR CIVIL PENALITIES.
Terms and conditions
I certify, to the best of my knowledge, that all information given by me in this application is true and correct. I authorize Mercy Regional Health Center to utilize this information in determining my pre-professional placement. I understand that false or misleading statements made by me or consequential omissions of any kind in the application process are sufficient causes for my not being accepted as a pre-professional or for my dismissal from the Mercy Pre-Professional Program. I understand that I will not be paid for my services as a Pre-Professional. I HAVE READ AND AGREE TO ADHERE TO THE CONDITIONS OF THIS CONFIDENTIALITY AGREEMENT. I ACKNOWLEDGE THAT ANY VIOLATION OF THE ABOVE CONDITIONS CAN RESULT IN DISCIPLINARY ACTION OR CONTRACT TERMINATION, SEVERENCE OR CIVIL PENALITIES.