Complete and submit this form AFTER you have successfully completed ALL of the learning required for your placement on the previous webpage. By submitting this form you verify that you have completed: You must have JavaScript enabled to use this form. First name Last name Date of birth Email Please select your role: Please select your role: - None -(Undergrad) Medical Student ElectiveOther… Enter other… Elective/Placement start date: Location - Select -LHSCSt. Joseph's To be determined Privacy and Confidentiality Declaration: I acknowledge and agree to the Privacy and Confidentiality responsibilities and have reviewed and the Privacy and Confidentiality Agreement Statement. Online Required Learning Training Declaration: I acknowledge the completion of all required learning education modules. Patient Care Systems Training Declaration: I acknowledge, if applicable, that I have completed the assigned Cerner Journeys or FirstNet online training.
