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Southwestern Oklahoma State University

College of Pharmacy

SWOSU > Academics > College of Pharmacy > Student Resources > Experiential Program > Forms > Pre-Rotations Pharmacy Practice Forms Instructions

Pre-Rotations Pharmacy Practice Forms Instructions

Send completed packet to the Pharmacy Practice Department Office in Oklahoma City below. The packet must be postmarked no later than the current Semester's date.

Dr. Christy F. Cox
Experiential Program Coordinator
SWOSU Pharmacy Practice Department
Pasteur Medical Building
1111 North Lee, Suite #241
Oklahoma City, OK 73103
(405) 601-8335
Fax: (405) 601-1201

Instructions

  1. Complete each form entirely.
    • completed Vitae Form (If you do not know where you will be living during your rotations at the time of mailing, please make a notation to that effect in the space provided for the address. Then notify Cassie Larman, Pharmacy Practice Secretary, (405) 601-2484, with this information no later than the first day of your rotation.)
    • signed and dated Practice Agreement form
    • HIPAA form, one will be signed and turned in at the briefing meeting and a second form will be signed at the briefing meeting and placed in your portfolio.
    • Hazards Forms (to be distributed, signed, witnessed, dated, and turned in at Briefing Meeting)
  2. The following should be in the student’s portfolio and the students will need to be able to provide to the Pharmacy Practice office or a rotation site if requested.
    • OSBI background check – the sexual offender box must be checked
    • Documentation of Professional Liability Insurance
    • Blood Borne Pathogen Certificate.
    • HIPAA form signed at the briefing meeting
    • Hazards Forms (to be distributed, signed, witnessed, dated, and turned in at Briefing Meeting)
  3. Students will need to be able to document a negative drug screen at the request of the Pharmacy Practice office or a rotation site.
  4. Immunizations and a current TB skin test must be on file by the due date below with SWOSU Student Health Services. Be sure to check the schedule for Student Health Services before leaving for break to ensure completion of health records by the due date (especially before leaving for the summer).  All students starting on rotations in January must have a TB skin test in November.  All Students starting rotations in April must have a TB skin test in April.
  5. Make 9 copies of the vitae.  Also make a copy of any other forms that you send to the Pharmacy Practice office
  6. The original vitae and pharmacy practice agreement must be postmarked by the experiential program coordinator at the address given at the bottom of this page no later than the current Semester's date. Late or incomplete forms will not be accepted.
  7. Take a copy of your vitae and your portfolio to your preceptor on the first day of each practice rotation. You may be required to provide copies to your rotation site of documents in your portfolio.
  8. Maintain 1 copy of the completed forms packet for your personal files.

Forms to be turned in to the Pharmacy Practice Office by the current semester date. 

  1. Vitae Form
  2. Practice Agreement Form
  3. Professional Liability Insurance (copy) Applications will be available for those who do not currently have Professional Liability Insurance.
  4. Concurrent Hours Form (fill in the semester in which you received credit for each) Note: concurrent hours may have been turned in at information meeting.
  5. HIPAA Document (turned in at briefing meeting)
  6. Hazards Forms (to be distributed, signed, witnessed, dated, and turned in at Briefing Meeting)