Allegiance Student Reg Form

Welcome to Henry Ford Allegiance Health! We are excited to invite you to join in our mission of leading our community to better health and well-being at every stage of life. To provide you with adequate access to our health system, please provide the following information. Most fields are required for registration.

Please read the below terms and conditions before submitting your registration.

  • Confidentilality Statement

    I understand that while at the hospital or other Henry Ford Allegiance Health facilities I will come into contact with confidential information and that it is necessary to protect this information. I understand and recognize that all information concerning a patient, physician or personnel is confidential and that an unauthorized disclosure by me of any confidential information violates the patients' and employees' right to confidentiality.

    I further understand that should I disclose confidential information, either directly or indirectly, that my student experience, internship or contract relationship with Henry Ford Allegiance Health shall cease.

  • Standards of Service Excellence

    I am compassionate.

    • I am concerned for our patient’s feelings, sympathetic to their discomfort and have a sincere desire to assist in helping them feel better.
    • I will treat all I serve in a positive manner and never become confrontational or raise my voice to anyone.
    • I will express sensitivity to the inconvenience of the patient experience. I understand that being a patient can sometimes create anxiety and I will do all I can to alleviate apprehension.

    I am competent.

    • I am able and qualified to perform efficiently and accurately, using my experience and training to provide the best care.
    • I will inform those I care for by introducing myself, explaining my purpose, describing my expertise, preparing them with what to expect and thanking them.
    • I will respond to all forms of communication including call lights, pages, emails, and voice mails in a time sensitive manner.
    • I will protect those I serve from exposure to safety risks and harmful elements.

    I provide excellent customer service.

    • I will listen, respond and follow-through with respect for privacy and with courtesy and consideration. I will explain to our patients what I am doing to protect privacy.
    • I will promptly answer the telephone with my name, department and a greeting of “how may I help you?”
    • I acknowledge those I pass on my way by making eye contact, and saying hello with a smile, greeting them in hallways, elevators, and all public areas.
    • I will assist anyone who appears to need directions by walking them to their destination.
    • I will park in designated areas so patients and visitors can easily access our facility.
    • I will round regularly on those I serve, making certain I have met their needs by asking, “Is there anything else I can do for you?”

    I value diversity.

    • I understand, appreciate and accept the differences in others and I respect others for who they are.
    • I appreciate that varied points of view and customs enrich our health system. I will be attentive to the differing needs of our patients and families.

    I value quality.

    • I am committed to excellence in care, processes and safety
    • I maintain a commitment to continuous improvement, seeking to find and implement better ways of doing things.
    • I do it right the first time to prevent duplicated work efforts.
    • I ask questions to determine the customer’s needs from their perspective.
    • I use resources, both human and material, wisely.
    • I assure patient safety.

    I provide a healing environment.

    • I offer peace, comfort, warmth, safety, cheer, cleanliness and gentle, individualized care.
    • I will show my concern and respect for our patients by minimizing noise levels throughout the hospital, keeping pagers and phones on silent and using a quiet voice.
    • We will all work together to keep our workplace, public corridors, and campus clean.
    • I will maintain a neat appearance, wear professional attire, and position my ID badge above the waist.

    I have integrity.

    • I am honest and I have high ethical standards. I can be depended upon to do the right thing at the right time for the right reason.
    • I will always ‘put patients first’ by prioritizing my work around their needs. I will attend to my personal business on my own time and focus on my work when I am at work.
    • I am accurate and take great care in thoroughly recording and documenting patient care and all aspects of my work.
    • I am respectful of property and equipment taking care in handling so as not to damage it.

    We are one team.

    • We work together – selflessly supporting one another in meeting the needs of our physicians, patients and our patient’s families.
    • I will never behave as though, “It’s not my job.”
    • I will keep those I serve informed of wait times and delays taking care to communicate that we are all focused on delivering excellent care, which often takes time.
    • I will express gratitude to my co-workers, volunteers, and physicians for their work.
    • I will avoid gossip or saying things which undermine others.
    • I will treat our physicians as both partners and customers, making our health system a rewarding and efficient place in which to practice medicine.
    • I will personally own any problem brought forward by using “service recovery” steps to resolve the issue.
  • Social Media Guidelines for Nurses
    Please be sure to watch this YouTube video
  • Student Parking Map

    Students are to park in Lot P. If a student acquires three parking tickets, he or she will not be allowed to come to campus for clinical experience.

    Download and Review

  • Registratin Fee
    This is a one-time $40 registration fee to cover the badge and other associated costs as a result of the on-boarding process. It will be need to be paid when the student picks up his/her badge from Human Resources. Cash or check only, please. The cost of a replacement badge is $10.

* Asterisk indicates required field.

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School, Department and Dates
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Influenza Vaccination
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Contact Information
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Vehicle Information
Agreement
You have read the Confidentiality Statement and Standards of Service Excellence, all questions have been answered and that you uphold its contents and hereby agree to be bound by the aforementioned agreement.
Checking this box is your electronic signature
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