Job Shadowing Agreement & Release Form

As a job shadowing program participant, I understand that I am not to be involved in the providing of patient care or in a patient care area without my assigned sponsor or his/her representative being present and if I breach this agreement, it may result in immediate termination of my job shadow assignment. 

  • I understand that even though I will only be observing, I may be exposed to certain risk of bodily injury or other dangers, including but not limited to, exposure to blood borne pathogens, biological waste, and dangerous chemicals, and I assume these risks.
     
  • I hereby release and forever discharge Butler County Health and its officers and employees from all claims, demands, rights and causes of action of whatever kind or nature arising from and by reason of any and all known and unknown, foreseen and unforeseen bodily and personal injuries, death, or damage to property arising out of my observation activities, including but not limited to, those specified risks itemized above.
     
  • I agree to conduct myself in a courteous and respectful manner to patients, visitors and staff while student shadowing at Butler County Health.
     
  • I agree to follow the dress code guidelines at Butler County Health.
     
  • I understand and take sole responsibility for any personal belongings I bring with me to Butler County Health.
     
  • I authorize the staff at Butler County Health to provide medical treatment in the case of an emergency.

I have read this document carefully and I voluntarily choose to participate in the activities described herein. 

(Required if Student is not 19 years of age)

The Parkinson's Empowerment Group at Butler County Health targets so many aspects and symptoms of Parkinson’s. It improves a person’s posture, mobility, balance, and coordination, as well as cognition and ability to multi-task. I also like the flexibility of the program and being able to adjust exercises from each position to fit the need of each individual patient.  

Andy Valenti, Physical Therapist Assistant

My strategy in nutrition coaching is to focus on the positive – what things could we add to increase the variety of healthy foods in your routine?  By focusing on adding more healthy choices, you will not feel deprived as you gradually leave out less nutritious choices.  My goal is to help you get a personalized approach to wellness that you can achieve and maintain with your current lifestyle.

Sandra Burwell, Registered Dietitian

Butler County Health has felt like home to me from the beginning of my employment.  I have spent more than 5 years working in an environment that has challenged me to pursue my nursing skills in many different areas such as the Emergency Department, Obstetrics, Inpatient Care, Outpatient Care and as Quality Improvement and Patient Safety Coordinator.

Tara Palensky, RN

BCH Roots to Shoots Pediatric Therapy Clinic eliminates the need for long commutes to distant facilities like Madonna, allowing Aria to maximize her therapy sessions and educational opportunities.  It is significant for Aria’s overall well-being as it reduces the stress and agitation she had from extended travel.  The staff is like our family to us.

Jennifer Prothman

The communication between us and Leia’s Roots to Shoots therapists is excellent.  We are given the tools and resources to practice techniques at home for ongoing progress and development so she can continue to thrive.  The entire staff at Roots to Shoots goes above and beyond what needs to be done; from teaching her to wear something as simple as a mask, to helping her feel comfortable riding in another vehicle like a school bus.  They are our angels.

Stacey Bykerk

I feel having a 3D mammogram was a blessing for me since it detected my Stage 1 cancer.  The technicians were very helpful as they explained how the machine worked compared to the 2D method.  A big difference is that the 3D machines moves above your head from one size to another and gives a more complete image of the breast.  The testing time also seemed shorter than the standard mammogram.

Judy Dubs

I had a bunion on my foot and I wanted it removed,  but I really didn't want to travel too far to have the procedure done.  So when Butler County Health started providing Podiatry Services, I made an appointment right away.  Dr. Carlston is professional and personable.  He took the time to explain what happens during the procedure and afterwards.

Jill Pokorny

Being able to have my blood drawn at Butler County Health saves me a weekly trip to Omaha.  It is simple to schedule an appointment that works with my schedule and the staff is quick and efficient at drawing my blood samples.

Tanner Zeilinger