Agreement Statements. [Advise staff where copies of relevant policies may be attained or insert link to the school website here.]
Agreement Statements. 1. Any observations, incidents, or conversations taking place during my time in school will be kept confidential.
Agreement Statements. As part of your treatment plan, your physician has recommended use of controlled medications. These medications can be very beneficial in treating certain diagnoses and disorders. However, because of the potential risks of abuse/misuse of these controlled medications, they must be treated in a manner different than other prescription medications. It is your responsibility to read this agreement, and to ask any questions about any sections that you do not completely understand. My provider has informed me about the reason this medication is being started. I have also discussed and understand the potential side effects of this medication as well as the risks of developing tolerance, physical dependence, habitation, and withdrawal problems; as well as the problems of substance abuse and dependence/addiction. I will use only one pharmacy for all of my controlled substance medications and I understand my provider has full authority to communicate with the pharmacist about my medical care and medications. Only my Primary Care Manager (PCM), Pain Management Clinic (PMC) provider or the provider responsible for oversight of my treatment plan will be responsible for prescribing my controlled substance medications unless written permission is given by the provider responsible for my treatment plan for me to obtain my prescriptions from another provider. Periodic unannounced assessments of my blood and/or urine may be performed to determine my adherence to the plan of care and to assess for toxic levels of medications or potential drug interactions. I will take the controlled medication(s) exactly as instructed by the provider responsible for my treatment plan, and will not increase my dose unless specifically instructed by the provider responsible for my treatment plan. Prescriptions may not be refilled early unless a change in dosing has been made by the provider responsible for my treatment plan. In accordance with federal law, I will not share my medication(s) with any other individual. I understand that I am responsible for my controlled medication(s) and lost or inaccessible prescriptions may not be refilled early. I will bring in containers of all medications prescribed by the provider responsible for my treatment plan each time I am seen by him or her, even if there is no medication remaining. These will be the original containers from the pharmacy for each medication. To assist my provider in understanding the rate at which I use my medications in order to m...
Agreement Statements. Any observations, incidents, or conversations taking place during my time in school will be kept confidential. I understand that it is my responsibility to support the safeguarding of pupils and other staff. If I have any Child Protection or Safeguarding concerns, or if I am asked to do something, or see something I consider not best practice, I will report this to [insert relevant staff member / role]. I understand the importance of upholding my online reputation, my professional reputation, and that of the school, and I will do nothing to impair either. I will conduct myself in a professional manner, including professional dress and using appropriate language at all times. I will never attempt to arrange any meeting, including tutoring session, without the full prior knowledge and approval of the school. I will not contact or attempt to contact any pupil in any way other than school-approved and school-monitored ways. I will not store school-related data on personal devices, storage, or cloud platforms. I will not access, attempt to access, store, or share any data which I do not have express permission for. I will not share any information about the school or members of its community, including verbally, electronically, or via social media that I gain as a result of my visit in any way, or on any platform, except where relevant to the purpose of my visit and agreed in advance with the school. I will not take photographs or videos whilst on site, unless the intent has been communicated to senior leaders and the purpose has been deemed appropriate and prior permission has been granted. (e.g. to take photos of equipment or buildings) I understand that school systems and users are protected by security, monitoring, and filtering services, and that my use of school devices and systems can be monitored/captured/viewed by the relevant authorised staff members. When using school-owned devices, networks, cloud platforms or other technology, I will use them exclusively for the purposes to which they have been assigned to me, and not for any personal use. I will not attempt to bypass security or monitoring, and will look after devices I have been given authorised use of. When using my own devices on school premises or accessing school systems / platforms, I will ensure I take appropriate steps to safeguard and secure my device. USB sticks / pen drives are not authorised unless permission has been sought from [insert staff member] (Remember these are a considerable...
Agreement Statements. 1. I understand that by signing this agreement I confirm receipt of the device (serial number as listed at the top of this document) and recognise that the loaned device remains the property of DCC.
