Preceptorship Contract – College Preceptorship Contract - College 11203 70 Street NW Edmonton, AB T5B 1T1 registration@theccoa.ca Preceptorship Application and Contract between the College of Chiropractors of Alberta (CCOA) and the Chiropractic College of the Named Student Date(Required) DD slash MM slash YYYY Student Name(Required) First Last Expected graduation date or 12th trimester date:(Required)Name of College:(Required)Representative applying on behalf of student:(Required)Email(Required) Preceptorship start date:(Required) DD slash MM slash YYYY Preceptorship end date:(Required) DD slash MM slash YYYY Understandings and Consent CCOA Agreement I, the chiropractic college representative, agree to abide by the following directions set by the CCOA. I understand that this contract can be cancelled at any time by the CCOA. I understand it is my responsibility to ensure that the student is covered by professional liability insurance. I understand all procedures performed by the student named must be directly supervised by a regulated chiropractor. I confirm that the named student has been instructed and is aware the following procedures may be performed: Obtain information for a patient entry Obtain a case history Conduct an examination, including a diagnosis that must be confirmed Use a deliberate, brief, fast thrust to move the joints of the spine beyond the normal range but within the anatomical range of motion, which generally results in an audible click or pop Insert or remove instruments, devices or fingers beyond the cartilaginous portion of the ear canal Insert or remove instruments, devices or fingers beyond the point in the nasal passages where they normally narrow and beyond the anal verge Reduce a dislocation of a joint Order any form of ionizing radiation in medical radiography, and nuclear medicine Apply any form of ionizing radiation in medical radiography Order non-ionizing radiation in magnetic resonance imaging, and ultrasound imaging Assist in rendering treatment for ultrasound, electro therapy, massage or trigger point therapy I confirm that the named student has been instructed that the following procedures may not be performed: Needle acupuncture Setting or resetting a fracture of a bone Understanding(Required) I have attached a copy of the certificate of liability protection naming the student identified above provided by this College. Liability protection between the student and their college must meet the minimum requirement in Alberta of at least $5 million per incident and $5 million cumulative. Representative of the College of Attendance Signature(Required)Date Signed(Required) DD slash MM slash YYYY Witness Signature(Required)Date Signed(Required) DD slash MM slash YYYY Questions? Please feel free to contact registration@theccoa.ca.
