Jr Hospital Of Cook County - University Of Illinois (Page 4 of 4) in pdf

Jr Hospital Of Cook County - University Of Illinois Page 4

John H. Stroger, Jr. Hospital of Cook County

Cook County Health & Hospital System

(formerly Cook County Bureau of Health Services)

Confidentiality. I acknowledge that all Hospital patient information is absolutely confidential and shall not

disclose directly, indirectly, or by implication, or use such information in any way at any time, except solely as

required to perform assigned tasks at the Hospital.

Professional Liability Insurance. If requested by the Hospital, I have provided the Department of Education and

Training with proof that I am covered by insurance which insures against professional liability I may incur while

participating in patient care activities at the Hospital.

10.

Volunteer Status. I understand that I will be paid no compensation by the County with respect to my activities at

the Hospital and that I am neither an employee of the County

nor am I entitled to any benefit to which County employees may be entitled such as, but not limited to,

compensation, retirement or disability benefits, workers’ compensation benefits or any other benefits.

11.

Governing Law. This Agreement shall be interpreted under and governed by the laws of the State of Illinois.

Venue shall lie in a court of competent jurisdiction located within the County of Cook, Illinois.

Signed by Student:

________________________________________

________________

Printed Name

Date

Acceptance by Hospital:

________________________________________

________________

Department of Planning, Education and Research

Date

Acceptance by Clinical Supervisor at Hospital:

________________________________________

________________

Department Chair

Date

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Jr Hospital Of Cook County - University Of Illinois Page 4