Common use of Personal Health Clause in Contracts

Personal Health. ▪ I will arrange an appointment with my primary care provider or XXXX travel clinic to ensure that, if necessary, pre-travel vaccinations, medications, malaria prophylaxis, HIV post-exposure prophylaxis, and other essential medications are obtained in sufficient time prior to departure (it is recommended to have a pre-travel appointment scheduled approximately two months prior to departure). ▪ I understand that I will be financially responsible for any items or dollar amount not covered through UCLA travel insurance (deductibles, exclusions, etc.). ▪ I will keep a copy of my travel health and evacuation insurance information with me on my person at all times during my international experience. ▪ I understand that some health problems may be exacerbated under stressful and unfamiliar situations. I have no physical or mental health issues that would preclude my safe participation in this program. ▪ I understand that there may be limited availability of medications and will be responsible for bringing my own supply of necessary medications (over the counter and prescription) for personal use. ▪ Prior to my departure I will review the emergency contact information with GHP and fully understand whom to contact both locally and at UCLA in case of illness, injury, or other unanticipated incidents that occur during this rotation. Initial here: ▪ I will or have already participated in GHP’s pre-departure orientation. ▪ I understand the recommendations to have a filled prescription for HIV post-exposure prophylaxis (PEP) (if applicable for my site and the nature of my rotation – appropriateness should be discussed during the pre- travel medical appointment and/or with GHP). ▪ I will utilize universal precautions at all times. Initial here:

Personal Health. ▪ I will arrange an appointment with my primary care provider or XXXX ASHE travel clinic to ensure that, if necessary, pre-travel vaccinations, medications, malaria prophylaxis, HIV post-exposure prophylaxis, and other essential medications are obtained in sufficient time prior to departure (it is recommended to have a pre-travel appointment scheduled approximately two months prior to departure). ▪ I understand that I will be financially responsible for any items or dollar amount not covered through UCLA travel insurance (deductibles, exclusions, etc.). ▪ I will keep a copy of my travel health insurance and evacuation insurance information with me on my person at all times during my international experience. ▪ I understand that some health problems may be exacerbated under stressful and unfamiliar situations. I have no physical or mental health issues that would preclude my safe participation in this program. ▪ I understand that there may be limited availability of medications and will be responsible for bringing my own supply of necessary medications (over the counter and prescription) for personal use. ▪ Prior to my departure I will review the emergency contact information with GHP and fully understand whom to contact both locally and at UCLA in case of illness, injury, or other unanticipated incidents that occur during this rotation. Initial here: ▪ I will or have already participated in GHP’s pre-departure orientation. ▪ I understand the recommendations to have a filled prescription for HIV post-exposure prophylaxis (PEP) (if applicable for my site and the nature of my rotation – appropriateness should be discussed during the pre- pre-travel medical appointment and/or with GHP). ▪ I will utilize universal precautions at all times. Initial here:

Personal Health. ▪ I will arrange an appointment with my primary care provider or XXXX travel clinic to ensure that, if necessary, pre-travel vaccinations, medications, malaria prophylaxis, HIV post-exposure prophylaxis, and other essential medications are obtained in sufficient time prior to departure (it is recommended to have a pre-travel appointment scheduled approximately two three months prior to departure). ▪ I will sign up for UCLA travel insurance, which will provide coverage for health issues while abroad, as well as coverage of lost or stolen items and evacuation should there be any conflict or safety concern while I am abroad (sign up at xxxxx://xxx.xxxx.xxx/risk- services-travel/index.html). ▪ I understand that I will be financially responsible for any items or dollar amount not covered through UCLA travel insurance (deductibles, exclusions, etc.). ▪ I will keep a copy of my travel health insurance and evacuation insurance information with me on my person at all times during my international experience. ▪ I understand that some health problems may be exacerbated under stressful and unfamiliar situations. I have no physical or mental health issues that would preclude my safe participation in this program. ▪ I understand that there may be limited availability of medications and will be responsible for bringing my own supply of necessary medications (over the counter and prescription) for personal use. ▪ Prior to my departure I will review the emergency contact information with GHP my UCLA faculty mentor and fully understand whom to contact both locally and at UCLA in case of illness, injury, illness or other unanticipated incidents that occur during this rotationinjury while working abroad. Initial hereHere: ▪ I will or have already participated in GHP’s pre-departure orientationtraining (xxxxx://xxxxxxxxxxx.xxx.xxxx.xxx/pages/travel_health_safety ). ▪ I understand the recommendations to have a filled prescription for HIV post-exposure prophylaxis (PEP) (if applicable for my site and the nature of my rotation – appropriateness should be discussed during the pre- pre-travel medical appointment and/or and with GHPyour faculty mentor). ▪ I will utilize universal precautions at all times. Initial hereHere:

Personal Health. ▪ I will arrange an appointment with my primary care provider or XXXX travel clinic to ensure that, if necessary, pre-travel vaccinations, medications, malaria prophylaxis, HIV post-exposure prophylaxis, and other essential medications are obtained in sufficient time prior to departure (it is recommended to have a pre-travel appointment scheduled approximately two months prior to departure). ▪ I understand that I will be financially responsible for any items or dollar amount not covered through UCLA travel insurance (deductibles, exclusions, etc.). ▪ I will keep a copy of my travel health insurance and evacuation insurance information with me on my person at all times during my international experience. ▪ I understand that some health problems may be exacerbated under stressful and unfamiliar situations. I have no physical or mental health issues that would preclude my safe participation in this program. ▪ I understand that there may be limited availability of medications and will be responsible for bringing my own supply of necessary medications (over the counter and prescription) for personal use. ▪ Prior to my departure I will review the emergency contact information with GHP and fully understand whom to contact both locally and at UCLA in case of illness, injury, or other unanticipated incidents that occur during this rotation. Initial here: ▪ I will or have already participated in GHP’s pre-departure orientation. ▪ I understand the recommendations to have a filled prescription for HIV post-exposure prophylaxis (PEP) (if applicable for my site and the nature of my rotation – appropriateness should be discussed during the pre- pre-travel medical appointment and/or with GHP). ▪ I will utilize universal precautions at all times. Initial here: