Professional Documents
Culture Documents
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AMERICAN RIVER COLLEGE
4700 College Oak Drive | Sacramento, CA 95841
For more information
(916) 484-8011
www.arc.losrios.edu
Los Rios Community College District
Parking Information
Visitor Parking
A visitor parking area with parking meters is
located by the Administration Building on College
Oak Drive. The cost is 25 per 15 minutes. (No
student parking is permitted in the visitors area.)
Visitor permits are available from the Information
Center in the Administration Building.
Parking Permits &
Daily Tickets
All vehicles on campus 7:00 a.m.11:00 p.m. must
display a permit or daily parking permit. Permits
are not required during non-school days and
weekends. For your protection, all vehicles should
be locked and all valuables stored out of sight.
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from machines located in each parking lot.
In case of machine malfunction, you may: 1)
Purchase a ticket from another machine; 2)
Contact a college police ofcer for a one-day
permit. Notes about machine malfunction will
not be accepted.
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session. A permit entitles the student to day
or evening college parking, and is available
from the Business Services Ofce located in
the Administration Building. Remember that
a parking permit does not guarantee a parking
space. A parking permit entitles you to park on
campus where and when space is available.
Handicapped
Parking
Automobiles of students with disabilities (and
persons providing transportation services to stu-
dents with disabilities) must display a semester or
daily parking permit as do other students. However,
special parking spaces for disabled students are
provided in all student parking lots. A placard
issued by the Department of Motor Vehicles for per-
sons with disabilities, or a distinguishing license
plate for persons with disabilities, must be properly
displayed on the vehicle. Temporary disability
permits are available from the Health Center; if
you are issued a temporary permit you must also
display a valid semester or daily parking permit.
Motorcycles
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Motorcycles may only park in designated
motorcycle areas. Motorcycles may not park in
regular student spaces.
Tow-Away
Vehicles parked illegally in red zones and vehicles
parked so as to impede the flow of traffic on
campus streets, lot entrances and driveways, in
front of re hydrants or in other areas where
emergency vehicles might be hindered, may be
subject to being towed away at owners expense
and inconvenience. Vehicles parked in staff or
handicapped spaces are subject to tow-away.
Driving to Campus
If you need directions or have any
questions, feel free to contact us at
(916) 484-8011 or check our
website: www.arc.losrios.edu
Parking Citations
Permits are not required during non-school
hours. A list of common violations is shown below,
although other regulations are also enforced
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College Police
The College Police ofce is located south of Davies
Hall (see reverse side).
s Ofce Hours
Mon-Fri, 8:00 am-5:00 pm
s 24-Hour Phone
(916) 558-2221
NURSE 100 - NURSE ASSISTANT
MEDICAL PACKET
Print out the following ARC Medical Forms
(4 Pages):
A. Health Clearance Checklist
B. Health History
C. Physical Exam
-26-
Health_Clearchk_NA (Revised 10/12/10)
AMERICAN RIVER COLLEGE
HEALTH CLEARANCE CHECKLIST
NURSE ASSISTANT PROGRAM
Upper Section To Be Completed by Student
Name Student ID No.
SEMESTER/YEAR: Fall
Spring
Medical Clearance Section To Be Completed by Program Nursing Instructor or Nursing Director
I. PHYSICAL EXAMINATION CLEARANCE
A. Health Care Provider's Signature and Stamp
AND
B. Physical Exam
$ Date physical exam completed ________________________
$ Obtained within one (1) year prior to program registration
$ Health care provider must check () #1. Can participate with no restrictions.
II. HEALTH HISTORY CLEARANCE
A. Completed by Student, With Student's Signature and Date
B. Health Care Provider's Signature and Stamp
III. TUBERCULOSIS CLEARANCE
A. PPD
$ Date Read_________________________
$ Obtained within last six (6) months prior to program registration
$ Copy of report form signed by medical staff who gave PPD injection. Skin results
documented as negative
OR
B. X-ray
$ Date Read_________________________
$ Obtained within last one (1) year prior to program registration
$ Chest X-ray results state: Negative CxR or no evidence of active (TB) disease
Nursing Instructor or Nursing Director will sign and date clearance.
DATE CLEARED BY
AMERICAN RIVER COLLEGE
Nurse Assistant Program
HEALTH HISTORY
The information on the health history form must be completed in its entirety and signed by the student. The
health care provider must also review and sign this form at the time of student's physical examination.
Student: All sections must be completed - upper section, questions, & signature.
Name LRCCD Student ID No.
Last First Middle
Health Care Provider
Health Care Providers Address
City, State, Zip
Health Care Providers Telephone Number
YES NO The following questions are to be answered by checking either "Yes" or "No".
Have you been under a doctor's care in the last 12 months?
Have you been in the hospital in the last 12 months?
Have you ever had any type of surgery?
Do you want to talk to a doctor about a health problem or any injury?
Have you ever been restricted from any activity or employment because of a health problem or injury?
Has anyone in your immediate family ever had:
Diabetes (high sugar in blood)?
Allergies (hay fever or asthma)?
Migraine headaches?
Heart trouble?
High blood pressure?
Has anyone in your family died suddenly?
Have you had or do you now have:
Brain concussion (head injury)?
Tendency to lose consciousness (faint)?
Skull fracture?
Convulsions or epilepsy?
Neck injury?
Impaired (poor) vision in one or both eyes?
Temporary loss of vision?
To wear glasses or contact lenses?
Hearing loss?
Perforated eardrum?
Discharge from ear(s) (recurrent infections)?
Sinus infections?
Broken nose?
Dental Plate (dentures)?
Orthodontia (teeth straightened)?
Have you had or do you now have?
Hernia?
Kidney problems?
Loss of function or absence of testicles (Men)?
Menstrual problems (Women)?
(OVER)
YES NO The following questions are to be answered by checking either "Yes" or "No".
Have you had or do you now have?
Bone fracture?
Joint dislocation?
Foot problems?
To wear a cast?
Back injury or frequent backaches
Knee injury (sprain) or recurrent pain?
Ankle injury (sprain) or recurrent pain?
Other joint problems, e.g., swelling pain, decreased range of motion?
Bone infection?
Have you had or do you now have?
Weight problem (under or overweight)?
Diabetes (high sugar in blood or urine)?
Tendency to bleed or bruise easily?
Anemia ("tired" blood)?
Heart trouble or murmur?
High blood pressure?
Persistent cough?
Chest pain with exercise?
Dizziness or faintness with exercise?
Asthma (wheezing)?
Hay Fever?
Hives or rash?
Bee sting reactions (allergy)?
Reaction to medicine (allergy)?
Have you had or do you now have?
Recurrent rash?
Fungus?
Athlete's foot?
Recurrent boils (skin infection)?
Do you....................
Smoke?
Take any medicine regularly?
If "yes", name of medication
Take medicine for emergency use?
If "yes", name of medication
If you answered "yes" to any question, please explain below.
I VERIFY THAT THE RESPONSES ON THIS QUESTIONNAIRE ARE CORRECT TO THE BEST OF MY KNOWLEDGE.
Student's Signature Date
HEALTH HISTORY REVIEWED BY:
Health Care Providers Signature Date
Verify Signature with
(Revised 08/24/10) Health Care Provider's Stamp
AMERICAN RIVER COLLEGE
PHYSICAL EXAM
NURSE ASSISTANT PROGRAM
Upper Section to Be Completed by Student Student ID Number
Last Name First Name MI
Address Phone
City & State Zip
Birth Date Age Sex Height Weight
To Be Completed by Health Care Provider
Blood Pressure Pulse Rate
Significant Medical History
Current Complaints of Disabilities Pertinent to Student=s Participation
EXAMINATION (SYSTEM REVIEW)
NORMAL
ABNORMAL
COMMENTS
1. General Appearance
2. Eyes
3. Ears, Nose & Throat
4. Mouth & teeth
5. Neck
6. Lymph Nodes
7. Respiratory
8. Cardiovascular
9. Abdomen
10 Genitalia-Hernia
11. Skin
12. Neuro
13. Musculoskeletal
Recommendations Regarding Participation in the Nurse Assistant Program
1. Can participate with no restrictions*
2. No participation until: *
3. No participation
*The health care provider verifies that the individual does not have any health condition that would create a hazard for himself/herself,
fellow employees, patients, and visitors.
NOTE: NO ACCOMMODATIONS ARE AVAILABLE FOR LIMITED, RESTRICTED, AND/OR PARTIAL PARTICIPATION.
Health Care Provider's Name: Please Review and Sign "Health History" Completed by Student
Verify Signature with
Health Care Provider's Signature Date Health Care Providers Stamp
Health Care Provider (Print) Telephone Number
Address, City, State, Zip (Print)
I hereby authorize release of pertinent medical records to American River College.
Students Signature Date