Common use of Personal Health Clause in Contracts

Personal Health.  I will arrange an appointment with my primary medical doctor or travel clinic, to ensure that pre-travel vaccinations, medications, malaria prophylaxis, and other essential medications are obtained in sufficient time prior to departure (it is recommended a pre- travel appointment be scheduled for two months prior to departure).  I will sign up for travel insurance which will provide coverage for health issues while abroad, coverage of lost or stolen items, as well as expatriation should there be any conflict or safety concern while I am abroad. I understand that I will be financially responsible for any items or dollar amount not covered through the travel insurance (deductibles, exclusions, etc).  I will keep a copy of my health insurance and evacuation insurance information with me on my person at all times during my international experience, and provide a copy to my team lead.  Health issues may be exacerbated under stressful and unfamiliar situations. I have no physical or mental health issues that would put me at risk or preclude my safe participation in this program. I understand that there may be limited availability of medications and will be responsible for bringing my own supply of necessary medications (over-the-counter and prescription) for personal use.  I understand that neither Xxxxxx Permanente nor the host institutions are responsible for expenses relating to any illness occurring during my international experience. I will be responsible for medical and medically related expenses and for seeking reimbursement from my travel insurance and/or my own health insurance company.  Prior to my departure I will review the emergency contact information with my Xxxxxx Permanente faculty mentor and fully understand whom to contact in case of illness or injury while working abroad. If I become ill or injured I will follow the notification process as outlined. Initial Here: Occupational Standards: • I will or have already participated in the Xxxxxx Permanente Global Health Education Program (GHEP) pre-departure training, or have reviewed the on-line health and safety talk and passed the quiz associated with this presentation. • I understand that I should always apply universal precautions, and that if there is possible exposure to HIV I will contact the nearest local health official to receive HIV post-exposure prophylaxis. • I will discuss with my faculty mentor whether I will need to bring N95 masks and gloves, or HIV post exposure prophylaxis, and will review with my mentor the appropriate situations for use of these precautions. • I will utilize universal precautions at all times. Initial Here:

Personal Health.  ▪ I will arrange an appointment with my primary medical doctor or travel clinic, to ensure that pre-travel vaccinations, medications, malaria prophylaxis, and other essential medications are obtained in sufficient time prior to departure (it is recommended a pre- travel appointment be scheduled for two months prior to departure).  ▪ I will sign up for travel insurance which will provide coverage for health issues while abroad, coverage of lost or stolen items, as well as expatriation should there be any conflict or safety concern while I am abroad. I understand that I will be financially responsible for any items or dollar amount not covered through the travel insurance (deductibles, exclusions, etc).  ▪ I will keep a copy of my health insurance and evacuation insurance information with me on my person at all times during my international experience, and provide a copy to my team lead.  ▪ Health issues may be exacerbated under stressful and unfamiliar situations. I have no physical or mental health issues that would put me at risk or preclude my safe participation in this program. I understand that there may be limited availability of medications and will be responsible for bringing my own supply of necessary medications (over-the-counter and prescription) for personal use.  ▪ I understand that neither Xxxxxx Permanente nor the host institutions are responsible for expenses relating to any illness occurring during my international experience. I will be responsible for medical and medically related expenses and for seeking reimbursement from my travel insurance and/or my own health insurance company.  ▪ Prior to my departure I will review the emergency contact information with my Xxxxxx Permanente faculty mentor and fully understand whom to contact in case of illness or injury while working abroad. If I become ill or injured I will follow the notification process as outlined. Initial Here: Occupational Standards: • I will or have already participated in the Xxxxxx Permanente Global Health Education Program (GHEP) pre-departure training, or have reviewed the on-line health and safety talk and passed the quiz associated with this presentation. • I understand that I should always apply universal precautions, and that if there is possible exposure to HIV I will contact the nearest local health official to receive HIV post-exposure prophylaxis. • I will discuss with my faculty mentor whether I will need to bring N95 masks and gloves, or HIV post exposure prophylaxis, and will review with my mentor the appropriate situations for use of these precautions. • I will utilize universal precautions at all times. Initial Here:

Personal Health.  ▪ I will arrange an appointment with my primary medical doctor or travel clinic, to ensure that pre-travel vaccinations, medications, malaria prophylaxis, HIV post-exposure prophylaxis, and other essential medications are obtained in sufficient time prior to departure (it is recommended a pre- pre-travel appointment be scheduled for two three months prior to departure).  ▪ I will sign up for UCLA travel insurance which will provide coverage for health issues while abroad, coverage of lost or stolen items, as well as expatriation should there be any conflict or safety concern while I am abroad. abroad (sign up at xxxxx://xxxxx.xxxxxxxxxxxx.xxxxxxx.xxx/servlet/guest?service=0&formId=2&enterprise=1.) I understand that I will be financially responsible for any items or dollar amount not covered through the UCLA travel insurance (deductibles, exclusions, etc).  .) ▪ I will keep a copy of my health insurance and evacuation insurance information with me on my person at all times during my international experience, and provide a copy to my team lead.  ▪ Health issues may be exacerbated under stressful and unfamiliar situations. I have no physical or mental health issues that would put me at risk or preclude my safe participation in this program. I understand that there may be limited availability of medications and will be responsible for bringing my own supply of necessary medications (over-the-counter and prescription) for personal use.  ▪ I understand that neither Xxxxxx Permanente UCLA nor the host institutions are responsible for expenses relating to any illness occurring during my international experience. I will be responsible for medical and medically medically---related expenses and for seeking reimbursement from my UCLA travel insurance and/or my own health insurance company.  ▪ Prior to my departure I will review the emergency contact information with my Xxxxxx Permanente UCLA faculty mentor and fully understand whom to contact in case of illness or injury while working abroad. If I become ill or injured I will follow the notification process as outlinedoutline ▪ Upon return to the U.S., I will schedule an appointment with Occupational Health within 1 week to check for any illnesses acquired abroad that might be transmissible. Initial Here: Occupational Standards: • I will or have already participated in the Xxxxxx Permanente UCLA Global Health Education Program (GHEP) pre-departure training, or have reviewed the on-line health and safety talk and passed the quiz associated with this presentation. • If engaging in clinical work or working in settings with the possibility of an HIV exposure, I understand that I should always apply universal precautions, and that if there is possible exposure the recommendations to HIV I will contact the nearest local health official to receive have a filled prescription for HIV post-exposure prophylaxisprophylaxis (PEP). • I will discuss with my faculty mentor whether I will need to bring N95 masks and gloves, or HIV post exposure prophylaxis, and will review with my mentor the appropriate situations for use of these precautions. • I will utilize universal precautions at all times. Initial Here:

Personal Health.  ▪ I will arrange an appointment with my primary medical doctor care provider or travel clinic, clinic to ensure that that, if necessary, pre-travel vaccinations, medications, malaria prophylaxis, HIV post-exposure prophylaxis, and other essential medications are obtained in sufficient time prior to departure (it is recommended to have a pre- pre-travel appointment be scheduled for two approximately three months prior to departure).  ▪ I will sign up for UCLA travel insurance insurance, which will provide coverage for health issues while abroad, as well as coverage of lost or stolen items, as well as expatriation items and evacuation should there be any conflict or safety concern while I am abroadabroad (sign up at xxxxx://xxx.xxxx.xxx/risk- services-travel/index.html). ▪ I understand that I will be financially responsible for any items or dollar amount not covered through the UCLA travel insurance (deductibles, exclusions, etc.).  ▪ I will keep a copy of my health insurance and evacuation insurance information with me on my person at all times during my international experience, and provide a copy to my team lead.  Health issues ▪ I understand that some health problems may be exacerbated under stressful and unfamiliar situations. I have no physical or mental health issues that would put me at risk or preclude my safe participation in this program. ▪ I understand that there may be limited availability of medications and will be responsible for bringing my own supply of necessary medications (over-the-over the counter and prescription) for personal use.  I understand that neither Xxxxxx Permanente nor the host institutions are responsible for expenses relating to any illness occurring during my international experience. I will be responsible for medical and medically related expenses and for seeking reimbursement from my travel insurance and/or my own health insurance company.  ▪ Prior to my departure I will review the emergency contact information with my Xxxxxx Permanente UCLA faculty mentor and fully understand whom to contact both locally and at UCLA in case of illness or injury while working abroad. If I become ill or injured I will follow the notification process as outlined. Initial Here: Occupational Standards: • ▪ I will or have already participated in the Xxxxxx Permanente Global Health Education Program (GHEP) GHP’s pre-departure training, or have reviewed the on-line health and safety talk and passed the quiz associated with this presentationtraining (xxxxx://xxxxxxxxxxx.xxx.xxxx.xxx/pages/travel_health_safety ). • ▪ I understand that I should always apply universal precautions, and that if there is possible exposure the recommendations to HIV I will contact the nearest local health official to receive have a filled prescription for HIV post-exposure prophylaxisprophylaxis (PEP) (if applicable for my site and the nature of my rotation – appropriateness should be discussed during the pre-travel medical appointment and with your faculty mentor). • I will discuss with my faculty mentor whether I will need to bring N95 masks and gloves, or HIV post exposure prophylaxis, and will review with my mentor the appropriate situations for use of these precautions. • ▪ I will utilize universal precautions at all times. Initial Here:

Personal Health.  I will arrange an appointment with my primary medical doctor or travel clinic, to ensure that pre-travel vaccinations, medications, malaria prophylaxis, HIV post-exposure prophylaxis, and other essential medications are obtained in sufficient time prior to departure (it is recommended a pre- pre-travel appointment be scheduled for two three months prior to departure).  I will sign up for UCLA travel insurance which will provide coverage for health issues while abroad, coverage of lost or stolen items, as well as expatriation should there be any conflict or safety concern while I am abroad. abroad (sign up at xxxxx://xxxxx.xxxxxxxxxxxx.xxxxxxx.xxx/servlet/guest?service=0&formId=2&enterprise=1.) I understand that I will be financially responsible for any items or dollar amount not covered through the UCLA travel insurance (deductibles, exclusions, etc). .)  I will keep a copy of my health insurance and evacuation insurance information with me on my person at all times during my international experience, and provide a copy to my team lead.  Health issues may be exacerbated under stressful and unfamiliar situations. I have no physical or mental health issues that would put me at risk or preclude my safe participation in this program. I understand that there may be limited availability of medications and will be responsible for bringing my own supply of necessary medications (over-the-counter and prescription) for personal use.  I understand that neither Xxxxxx Permanente UCLA nor the host institutions are responsible for expenses relating to any illness occurring during my international experience. I will be responsible for medical and medically medically---related expenses and for seeking reimbursement from my UCLA travel insurance and/or my own health insurance company.  Prior to my departure I will review the emergency contact information with my Xxxxxx Permanente UCLA faculty mentor and fully understand whom to contact in case of illness or injury while working abroad. If I become ill or injured I will follow the notification process as outlinedoutline  Upon return to the U.S., I will schedule an appointment with Occupational Health within 1 week to check for any illnesses acquired abroad that might be transmissible. Initial Here: Occupational Standards: • I will or have already participated in the Xxxxxx Permanente UCLA Global Health Education Program (GHEP) pre-departure training, or have reviewed the on-line health and safety talk and passed the quiz associated with this presentation. • If engaging in clinical work or working in settings with the possibility of an HIV exposure, I understand that I should always apply universal precautions, and that if there is possible exposure the recommendations to HIV I will contact the nearest local health official to receive have a filled prescription for HIV post-exposure prophylaxisprophylaxis (PEP). • I will discuss with my faculty mentor whether I will need to bring N95 masks and gloves, or HIV post exposure prophylaxis, and will review with my mentor the appropriate situations for use of these precautions. • I will utilize universal precautions at all times. Initial Here:

Personal Health.  ▪ I will arrange an appointment with my primary medical doctor or travel clinic, to ensure that pre-travel vaccinations, medications, malaria prophylaxis, HIV post-exposure prophylaxis, and other essential medications are obtained in sufficient time prior to departure (it is recommended to have a pre- pre-travel appointment be scheduled for two approximately three months prior to departure).  ▪ I will sign up for UCLA travel insurance which will provide coverage for health issues while abroad, coverage of lost or stolen items, as well as expatriation should there be any conflict or safety concern while I am abroad. abroad (sign up at xxxxx://xxx.xxxx.xxx/risk-services/loss- prevention-control/travel-assistance/) ▪ I understand that I will be financially responsible for any items or dollar amount not covered through the UCLA travel insurance (deductibles, exclusions, etc).  .) ▪ I will keep a copy of my health insurance and evacuation insurance information with me on my person at all times during my international experience, and provide a copy to my team lead.  ▪ Health issues may be exacerbated under stressful and unfamiliar situations. I have no physical or mental health issues that would put me at risk or preclude my safe participation in this program. I understand that there may be limited availability of medications and will be responsible for bringing my own supply of necessary medications (over-the-counter and prescription) for personal use.  ▪ I understand that neither Xxxxxx Permanente UCLA nor the host institutions are responsible for expenses relating to any illness occurring during my international experience. I will be responsible for medical and medically medically-related expenses and for seeking reimbursement from my UCLA travel insurance and/or or my own health insurance company.  ▪ Prior to my departure I will review the emergency contact information with my Xxxxxx Permanente UCLA faculty mentor and fully understand whom to contact in case of illness or injury while working abroad. If I become ill or injured injured, I will follow call the notification process as outlinedemergency hotline, following instructions provided during the pre-departure orientation. Initial Here: Occupational Standards: • I will or have already participated in the Xxxxxx Permanente UCLA Global Health Education Program (GHEP) pre-departure training, or have reviewed the on-line health and safety talk and passed the quiz associated with this presentation. • If engaging in clinical work or working in settings with the possibility of an HIV exposure, I understand that I should always apply universal precautions, and that if there is possible exposure the recommendations to HIV I will contact the nearest local health official to receive have a filled prescription for HIV post-exposure prophylaxisprophylaxis (PEP). • I will discuss with my faculty mentor whether I will need to bring N95 masks and masks, gloves, and or HIV post exposure prophylaxisother personal protective equipment (PPE), and will review with my mentor the appropriate situations faculty best practices for use of these precautionsPPE. • I will utilize universal precautions at all times. Initial Here: