University of Tennessee Medical Center Outside Learner/Observer Experience Registration

Limit requested observation date to actual approved observance dates approved by the sponsoring care provided. Requests with exended dates may be delayed and require additional approval or require submission of additional Outside Learner/Observer Experience Registration form.  Research assistants and clinical liasions can request up to a maxium of six months.

Vaccinations: We encourage you to be up-to-date with all recommended vaccines before you begin the observational experience. Documentation of the requested vaccines helps to ensure that observers understand our expectations to protect our patients, families and themselves. We reserve the right to request additional documentation regarding vaccination records as needed. Failure to provide documentation will result in delay or unapproved experience.

Declination of influenza vaccine will require approved outside learner/observer to wear a surgical mask during observational experience for the duration of flu season (typically October 1st - March 31st).

COVID-19 Vaccinations:

On December 28, 2021, the Centers for Medicare & Medicaid Services (CMS) updated their rule which establishes a COVID-19 vaccine requirement for healthcare workers in 25 states, including Tennessee. The medical center must comply with these regulations under the Medicare health and safety standards known as Conditions of Participation or Conditions for Coverage. We are required to abide by this mandate to participate in Medicare and Medicaid programs.  

UT Medical Center is required to extend the requirements of this regulation to all students/outside learners who visit the UTMC campus. Please note that being fully vaccinated does not require having a booster shot at this point in time. 

We are happy to offer it to you free of charge through our vaccine clinic at the link below.

https://vaccine1.utmedicalcenter.org/

If you have chosen not to be vaccinated against COVID-19, you can submit an exemption form to see if you are eligible for an approved exemption. These will be reviewed by a committee through a fair and confidential review process protecting health information.

We cannot accept the history of the chicken pox as an indication of Varicella immunity.

All submissions must be reviewed for completeness and the requested experience/dates must be confirmed with sponsoring healthcare provider.  Please allow 30 days for review. An email request will be sent to the observer to address any incomplete information. Once all information is complete and confirmation of experience is approved, an email will be sent to observer/sponsoring healthcare provider regarding next steps.

Distribution of Form:

Please print 3 copies of the completed form before clicking submit button.  

• Copy to be maintained in departmental file
• Copy to Human Resources if identification badge is required
• Copy to outside learner/observer