LHSC Student Registration Form

Thank you for completing the on-line orientation program. It has provided you with important information pertaining to your non-medical student experience at London Health Sciences Centre. Please ensure that you have reviewed the orientation modules carefully, as it is expected that you will know the information for your time spent at LHSC. It is also expected that you will remain up to date on policies and procedures while on-site at LHSC.

By submitting this registration form, you verify that you have completed the orientation modules, you receive credit for completing the on-line orientation program, and you complete your registration with Student Affairs, which is required in order for you to be a non-medical student on-site at London Health Sciences Centre.

Note: Do not enter a username or password into the login information to the right. This is for Student Affairs' use only.

Personal information on this form is collected under the authority of the Public Hospitals Act, Reg. 965, and will be used for the purposes of student placement and to facilitate compliance with public hospitals' legislated accountabilities at London Health Sciences Centre. Questions about this collection should be directed to Student Affairs, 750 Baseline Road, Suite 201, London, Ontario, Canada N6C 2R6, 519-685-8500 extension 76500, www.lhsc.on.caStudent_Affairs@lhsc.on.ca.

PART 1: Personal Information
PART 2: Placement Information
PART 3: School/Corporation Contact Information (enter 'not applicable' if this experience is NOT practicum/co-op/thesis/project work for your academic/training program)
PART 4: Additional Information
PART 5: IV Direct Administration – IP Students Only
PART 6: Panic Alarms
PART 7: Online Training Modules

The LHSC online orientation and training modules provide important information for your student placement and are a mandatory requirement to be on site at London Health Sciences Centre. 

PART 8: Young Workers
PART 9: Privacy and Confidentiality
I confirm that I have completed LHSC’s online Privacy and Confidentiality Education Program and that I understand my responsibilities for the confidentiality and security of patient information. I commit to:• respect patients’ right to privacy,• keep patient information entrusted to me as confidential and secure regardless of the format of the information • access, use and disclose only the patient information needed to fulfill my student placement • ensure the confidentiality and security of logins to patient care systems as well as other hospital systems to reduce risk of unauthorized access or use • also hold in confidence staff and affiliate information as well as the confidential business information of the organization• be familiar with and comply with LHSC’s policies and procedures regarding privacy, confidentiality and security of confidential information• immediately notify the LHSC Privacy Office if I become aware of a potential or actual privacy or security breach of confidential information• maintain my obligations related to privacy, confidentiality and security of confidential information even after my LHSC student placement endsI understand that I may consult my LHSC Student Supervisor/Preceptor or the LHSC Privacy Office for questions regarding my privacy, confidentiality and information security responsibilities. I understand that any unauthorized access to, use of, disclosure of, or failure to safeguard patient information, or the confidential information of staff and affiliates or the confidential business information of the organization may result in action, up to and including termination of my student placement at LHSC.
PART 10: Accommodation Needs
Select one option below
PART 11: Declaration
The E-Signature will have the same binding effect as an original signature