Common use of Personal Health Clause in Contracts

Personal Health. ▪ I will arrange an appointment with my primary medical doctor or travel clinic, to ensure that 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 three months prior to departure). ▪ I will sign up for UCLA travel insurance which will provide coverage for health issues while abroad, coverage of lost or stolen items, as well as expatriation should there be any conflict or safety concern while I am abroad (sign up at xxxxx://xxx.xxxx.xxx/risk-services/loss- prevention-control/travel-assistance/) ▪ 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 health insurance and evacuation insurance information with me on my person at all times during my international experience. ▪ Health issues may be exacerbated under stressful and unfamiliar situations. I have no physical or mental health issues that would put me at risk or 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. ▪ I understand that neither UCLA nor the host institutions are responsible for expenses relating to illness occurring during my international experience. I will be responsible for medical and medically-related expenses and for seeking reimbursement from UCLA travel insurance or my own health insurance company. ▪ Prior to my departure I will review the emergency contact information with my UCLA faculty mentor and fully understand whom to contact in case of illness or injury while working abroad. If I become ill or injured, I will call the emergency hotline, following instructions provided during the pre-departure orientation. Initial Here: • I will or have already participated in the UCLA Global Health Education Program (GHEP) pre-departure training. • If engaging in clinical work or working in settings with the possibility of an HIV exposure, I understand the recommendations to have a filled prescription for HIV post-exposure prophylaxis (PEP). • I will discuss with my faculty mentor whether I will need to bring N95 masks, gloves, and or other personal protective equipment (PPE), and will review with faculty best practices for use of PPE. • I will utilize universal precautions at all times. Initial Here:

Personal Health. ▪ I will arrange an appointment with my primary medical doctor or travel clinic, to ensure that 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-pre- travel appointment be scheduled approximately three for two months prior to departure). ▪ I will sign up for UCLA travel insurance which will provide coverage for health issues while abroad, coverage of lost or stolen items, as well as expatriation should there be any conflict or safety concern while I am abroad (sign up at xxxxx://xxx.xxxx.xxx/risk-services/loss- prevention-control/travel-assistance/) ▪ abroad. I understand that I will be financially responsible for any items or dollar amount not covered through UCLA the travel insurance (deductibles, exclusions, etc.) ). ▪ I will keep a copy of my health insurance and evacuation insurance information with me on my person at all times during my international experience, and provide a copy to my team lead. ▪ Health issues may be exacerbated under stressful and unfamiliar situations. I have no physical or mental health issues that would put me at risk or 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. ▪ I understand that neither UCLA Xxxxxx Permanente nor the host institutions are responsible for expenses relating to any illness occurring during my international experience. I will be responsible for medical and medically-medically related expenses and for seeking reimbursement from UCLA my travel insurance or and/or my own health insurance company. ▪ Prior to my departure I will review the emergency contact information with my UCLA Xxxxxx Permanente faculty mentor and fully understand whom to contact in case of illness or injury while working abroad. If I become ill or injured, injured I will call follow the emergency hotline, following instructions provided during the pre-departure orientationnotification process as outlined. Initial Here: • I will or have already participated in the UCLA Xxxxxx Permanente Global Health Education Program (GHEP) pre-departure training, or have reviewed the on-line health and safety talk and passed the quiz associated with this presentation. • If engaging in clinical work or working in settings with the possibility of an HIV exposure, I understand that I should always apply universal precautions, and that if there is possible exposure to HIV I will contact the recommendations nearest local health official to have a filled prescription for receive HIV post-exposure prophylaxis (PEP)prophylaxis. • I will discuss with my faculty mentor whether I will need to bring N95 masks, masks and gloves, and or other personal protective equipment (PPE)HIV post exposure prophylaxis, and will review with faculty best practices my mentor the appropriate situations for use of PPEthese precautions. • I will utilize universal precautions at all times. Initial Here:

Personal Health. ▪  I will arrange an appointment with my primary medical doctor or travel clinic, to ensure that 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-pre- travel appointment be scheduled approximately three for two months prior to departure). ▪  I will sign up for UCLA travel insurance which will provide coverage for health issues while abroad, coverage of lost or stolen items, as well as expatriation should there be any conflict or safety concern while I am abroad (sign up at xxxxx://xxx.xxxx.xxx/risk-services/loss- prevention-control/travel-assistance/) ▪ abroad. I understand that I will be financially responsible for any items or dollar amount not covered through UCLA the travel insurance (deductibles, exclusions, etc.) ▪ ).  I will keep a copy of my health insurance and evacuation insurance information with me on my person at all times during my international experience, and provide a copy to my team lead. ▪  Health issues may be exacerbated under stressful and unfamiliar situations. I have no physical or mental health issues that would put me at risk or 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. ▪  I understand that neither UCLA Xxxxxx Permanente nor the host institutions are responsible for expenses relating to any illness occurring during my international experience. I will be responsible for medical and medically-medically related expenses and for seeking reimbursement from UCLA my travel insurance or and/or my own health insurance company. ▪  Prior to my departure I will review the emergency contact information with my UCLA Xxxxxx Permanente faculty mentor and fully understand whom to contact in case of illness or injury while working abroad. If I become ill or injured, injured I will call follow the emergency hotline, following instructions provided during the pre-departure orientationnotification process as outlined. Initial Here: • I will or have already participated in the UCLA Xxxxxx Permanente Global Health Education Program (GHEP) pre-departure training, or have reviewed the on-line health and safety talk and passed the quiz associated with this presentation. • If engaging in clinical work or working in settings with the possibility of an HIV exposure, I understand that I should always apply universal precautions, and that if there is possible exposure to HIV I will contact the recommendations nearest local health official to have a filled prescription for receive HIV post-exposure prophylaxis (PEP)prophylaxis. • I will discuss with my faculty mentor whether I will need to bring N95 masks, masks and gloves, and or other personal protective equipment (PPE)HIV post exposure prophylaxis, and will review with faculty best practices my mentor the appropriate situations for use of PPEthese precautions. • I will utilize universal precautions at all times. Initial Here:

Personal Health. ▪ I will arrange an appointment with my primary medical doctor or travel clinic, to ensure that 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 be scheduled approximately for three months prior to departure). ▪ I will sign up for UCLA travel insurance which will provide coverage for health issues while abroad, coverage of lost or stolen items, as well as expatriation should there be any conflict or safety concern while I am abroad (sign up at xxxxx://xxx.xxxx.xxx/risk-services/loss- prevention-control/travel-assistance/xxxxx://xxxxx.xxxxxxxxxxxx.xxxxxxx.xxx/servlet/guest?service=0&formId=2&enterprise=1.) ▪ 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 health insurance and evacuation insurance information with me on my person at all times during my international experience. ▪ Health issues may be exacerbated under stressful and unfamiliar situations. I have no physical or mental health issues that would put me at risk or 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. ▪ I understand that neither UCLA nor the host institutions are responsible for expenses relating to any illness occurring during my international experience. I will be responsible for medical and medically----related expenses and for seeking reimbursement from UCLA travel insurance or and/or my own health insurance company. ▪ Prior to my departure I will review the emergency contact information with my UCLA faculty mentor and fully understand whom to contact in case of illness or injury while working abroad. If I become ill or injuredinjured I will follow the notification process as outline ▪ Upon return to the U.S., I will call the emergency hotline, following instructions provided during the pre-departure orientationschedule an appointment with Occupational Health within 1 week to check for any illnesses acquired abroad that might be transmissible. Initial Here: • I will or have already participated in the UCLA Global Health Education Program (GHEP) pre-departure training, or have reviewed the on-line health and safety talk and passed the quiz associated with this presentation. • If engaging in clinical work or working in settings with the possibility of an HIV exposure, I understand the recommendations to have a filled prescription for HIV post-exposure prophylaxis (PEP). • I will discuss with my faculty mentor whether I will need to bring N95 masks, masks and gloves, and or other personal protective equipment (PPE), and will review with faculty best practices my mentor the appropriate situations for use of PPEthese precautions. • I will utilize universal precautions at all times. Initial Here: