Effective Date: 
Wed, 12/01/2004
Tue, 03/13/2018
Fri, 03/23/2018

The UC Santa Cruz Academic Senate passed a policy in 2007 which states that instructors will not routinely require verification of illness/injury for students missing class.


The Student Health Center does not routinely provide authorization of class absence notes for students.  The clinical staff, at their discretion can provide absence excuses and functional impairments as appropriate.  A patient handout (Verification of Visit) explaining this policy and providing space for verifying dates and times of SHS appointments can be routinely provided to students by any staff member. 


Fri, 06/01/2018
Fri, 06/01/2018


PERSONNEL: RN, LVN, MA upon orders of clinician


  • Compressor,
  • Nebulizer Tubing
  • Medications as ordered by the Clinician: Albuterol Sulfate Inhalation Solution 0.083% and/or Ipratropium Bromide Inhalation Solution 0.02%
  • Fluids to rinse mouth



Effective Date: 
Thu, 08/04/2011
Fri, 06/01/2018
Mon, 10/23/2017

SUBJECT: Electrocardiogram Procedure


EQUIPMENT: Midmark 12-lead IQ EKG


Connect the portable unit to an exam room computer’s USB port. Snap lead attachment into base of portable unit. Open the correct patient’s visit note and confirm nursing order, if needed.

Assure patient there is no danger or pain involved. Have the patient remove clothing above the waist and don in a cloth gown opening to the front. Make the patient comfortable lying down on the exam table. Expose the arms and legs. If necessary shave the electrode areas before cleaning the exposed skin with alcohol for proper electrode adhesion.

Limb Sensor Application
Place the sensors on a smooth fleshy area of the upper inner arms and lower inner legs. Attach the limb leads.
Chest Sensor Application
Place the 6 Chest sensors on the patient’s chest as follows:
V1 Fourth intercostal space at right border of the sternum
V2 Fourth intercostal space at left border of the sternum
V3 Midway between position V2 and position V4
V4 At the mid-clavicular line in the fifth intercostal space
V5 At the anterior axillary line on the same horizontal level as V4
V6 At the mid-axillary line on the same horizontal level as V4 and V5
Attach the chest leads.


Confirm that standard vital signs obtained and entered into chart note, included current height and weight. If not, perform vitals before starting EKG.

Confirm chart note is closed before starting EKG.

12-LEAD and RHYTHM STRIP Capture

From the patient’s chart:

  • Select EKG/PFT from list on left side of screen
  • Select Acquire > ECG at top of screen and enter ordering clinician’s name (see below for Psychiatry process)
  • The Midmark module will open automatically
  • When you have clean tracing, click Analyze to capture the 12-lead
    • If tracing shows interference, confirm patient is still, no metal in pockets, leads placed correctly, etc.
  • Click RR to capture rhythm strip; it is set to record for 30 seconds
    • After recording 30 seconds of rhythm strip, the Review option becomes available; click it to save the results
  • Confirm that both 12-lead and rhythm strip documents have saved before notifying clinician

When done as part of a clinician visit, consult with ordering provider or other appropriate clinical staff before disconnecting leads and allowing patient to dress.

If either tracing needs to be redone, the Medical Records Systems Administrator must be notified to remove the unwanted tracing(s). Send an IM through the EMR with specific date and time information for the tracing(s) that need to be deleted.

If done as a nursing visit or through Psychiatry, see below.

Charge captured automatically when EKG is documented as performed through PnC>Open Chart>Nursing>Procedure Sheet.


We do not routinely submit all EKGs for review by an outside specialist. The need for outside review is at the discretion of the ordering clinician. Requests for interpretation by a specialist are documented on the tracing by the ordering clinician, then tracked by the Health Information Management (HIM) Department.

Documentation for 12-lead and RR consists of four steps:

  • Review
  • Enter Comments-“Keep”, “Send out”, relevant clinical information, initials
  • Sign
  • Acknowledge

EKGs ordered within a clinician visit, whether normal or abnormal, must be reviewed by the ordering clinician, who will determine patient disposition and whether the 12-lead and RR are “Keep” or “Send out”.  

The ordering provider or their designee clicks Review, enters “Keep” or “Send out” in the Comment section of each, initials each entry, then Exits and Saves the changes.

12-Lead: Auto-generated interpretation appears on document. To record comments, including “Keep” or “Send out”, click “Review”, click “Details”, then “Edit Comment” to open Comment section. Type comments, including relevant clinical information for the outside specialist, click “OK”, click “OK” again, and “Exit”, then “Yes” to save changes.

RR: No auto-generated interpretation appears on document; Comment section directly opens during Review process.

If “Keep”:

  • Enter Comments, initial the entry, Exit and Save changes
  • Sign
  • Acknowledge

If “Send out”:

  • The ordering provider or their designee clicks Review, enters “Send out” in the Comment section of each, adds any relevant clinical information, initials each entry, Exits and Saves the changes.  DO NOT SIGN OR ACKNOWLEDGE AT THIS STEP.
  • Health Information Management (HIM) runs daily report of unacknowledged EKGs and sends secure message to outside specialist to request reading, using the designated “EKG Clinician” provider in the EMR.
  • Outside specialist remotely accesses EMR at regular intervals and reads any pending EKGs and RRs.
  • Specialist adds interpretation in Comments and Signs electronic documents.
  • Health Information Management (HIM) notifies ordering clinician when 12-lead and RR has been reviewed and signed by the outside specialist, making it ready for acknowledgement.
  • Ordering clinician Acknowledges interpreted 12-lead and RR.

If an urgent interpretation is indicated, the Medical Director will communicate directly with the outside specialist.

Nurse-performed EKG for Routine Testing: As part of a physical prior to be being seen by a clinician (i.e. diving physical).

  • Nurse performs 12-lead and RR, designating the Medical Director as the ordering clinician.
  • Normal: Patient is discharged. The Medical Director will review the tracings and enter “Keep” or “Send out” comments.
  • Abnormal Results: If the automated reading reports anything other than “normal” or if the nurse has any clinical concerns, the EKG will be reviewed by the DOC or Medical Director prior to the patient leaving.
  • Charge captured automatically when EKG is documented as performed through PnC>Open Chart>Nursing>Procedure Sheet. If no order exists on the Procedure Sheet, charges must be entered separately.

EKGs ordered by Psychiatry: All EKGs ordered by Psychiatry are considered "Diagnostic".

  • The nursing order is placed by the psychiatrist.
  • The nurse/MA enters the Medical Director, not the psychiatrist, as the ordering clinician in the patient’s chart.
  • Normal: Results are reviewed by the Medical Director, who will determine “Keep” or “Send out”.
  • Abnormal results: If the automated reading reports anything other than “normal” or if the nurse/MA has any clinical concerns, the EKG will be reviewed by the DOC or Medical Director prior to the patient leaving.
  • Charge captured automatically when EKG is documented as performed through PnC>Open Chart>Nursing>Procedure Sheet.


  • HIM staff runs unacknowledged EKG report daily to determine the following:
    • If “Keep” but unacknowledged, HIM staff will alert the ordering provider regarding signing and acknowledging EKG.
    • If “Send out”, HIM staff monitors unacknowledged EKG and alerts ordering provider when outside specialist has entered documentation and signed the 12-lead and RR. HIM staff will alert the ordering provider regarding acknowledging EKG.









Effective Date: 
Sat, 12/04/2004
Tue, 08/23/2011
Fri, 08/26/2011

Nurses may initiate or assist students in receiving help from the DRC for temporary disabilities by documenting information noted below for the student to take to DRC. In the event of questions or serious mobility issues, the nurse should call and discuss with DRC prior to sending student there. Students with permanent disabilities usually have already been in contact with DRC and will have to provide documentation of prior medical evaluation.

Disability Resource Center (DRC) Requests


Effective Date: 
Mon, 01/02/2012
Wed, 01/14/2015

This policy clarifies the procedure for giving the injectable contraceptive Depo-Provera (Depo, DMPA).     The policy clarifies the procedure for patients who are late receiving their repeat Depo-Provera injections, allowing the nurse to provide on-going contraception by using the "quick start" algorithm (attached below).  This algorithm guides the nurse to assist women in need of on-going contraception who present after the standard 14 week (98 day) guideline for repeat injection.

Patient makes an appointment for Depo injection or is seen as a COPE RN visit. Nurse may administer Depo Provera in AIT, Same Day Clinic or by Nurse appointments


Injectable Contraceptive-Depo-Provera Patient Information Handout, HC266
Depo-Provera in a vial or pre-filled syringe containing 150mg DMPA per ml
21 or 23 gauge safety needle
A signed order from a Clinician at CSHC or per RN Standardized Procedure through the COPE or quick contraceptive refill procedure



First Injection:

Assure that a signed order from a clinician at SHC is appropriately entered into the PNC medical record, or meets the criteria for COPE as per the UCSC RN Standardized Procedures.

A urine pregnancy test is done prior to the initial injection.  If it is positive, proceed with pregnancy test visit.  If it is negative, proceed with Depo injection process.

Patient reads Injectable Contraceptive handout and is given the opportunity to ask any questions or clarify any concerns.

The first dose of Depo-Provera is given according to the Quick Start Algorithm.

Following standardized nursing practice, nurse gives IM injection and documents in the EMR.

DMPA 150mg/1 ml is given in a single injection deeply in the gluteus maximus or deltoid muscle using a 21 or 23g needle.

Patient waits 15 minutes after injection and prior to leaving to be observed for possible local site allergic reaction.

Nurse instructs patient to use a back-up contraceptive method for one week and to schedule follow-up appointment for the next injection every 12 weeks.  If Depo initial injection was initiated via COPE, the follow-up injections require a clinician order.  The Nurse assists the student in arranging a clinican appointment if indicated for on-going orders.

Follow-up Injections:

Nurse reviews side effects and patient concerns with attention to change in periods. A pregnancy test will be repeated prior to the second injection. If negative, the nurse will administer the second injection.

Obtain weight and blood pressure.  If weight is up more than 10% or BP is >130/>90, refer for clinician evaluation.

Discuss STI risk and/or testing.  Order STI testing as indicated.  Review STI risk reduction as indicated.

Follow-up injections less than 14 weeks (98 days) from previous injection:

Give Depo-Provera per protocol.  No urine pregnancy testing is necessary after the second visit if seen within 14 weeks of prior injection.

Patient waits 15 minutes after injection to observe for allergic reaction.

Follow-Up injection More than 14 weeks (98 days) from previous injection:

With history of unprotected intercourse after 14 weeks, offer emergency contraception if appropriate. 

Obtain a urine pregnancy test if indicated.  If negative, reassure the patient that the hormone injection will not harm an unrecognized pregnancy.  If the student still wishes to proceed, give the Depo.

Instruct the patient to use a back-up method of birth control for 1 week following the injection. 

Schedule and emphasize a return visit in 3 weeks for repeat pregnancy test.

Create a reminder/future callback in EMR to call patient in 3 weeks to return for pregnancy test.


Key Points: 

Pregnancy tests are required prior to the first two injections and as needed if delay of greater than 98 days since prior injection.

Planned pregnancies are associated with improved health for both women and babies.  Every attempt should be made to provide appropriate contraception to avoid unintended pregnancy.  This guideline has been modified to facilitate on-going use of injectable contraception for women who fail to return as scheduled for repeat Depo-Provera injections. 

In addition, this protocol has been revised to remove the requirement that a woman sign a special consent to use this type of contraception.

In accordance with World Health Organization guidance, this protocol removes warnings about loss of bone mineral density in women using Depo Provera.  Longitudinal research suggests that this loss of bone mineral density is transient, returning to baseline when women stop using Depo.  The research also indicates that women using this form of contraception do not have more bone fractures than women who don't use this contraceptive.


Effective Date: 
Wed, 12/01/2004
Mon, 05/14/2018
Mon, 05/14/2018



EQUIPMENT: RED CART, AEDs, Oxygen tanks, Emergency Response Bags, Suction Machine

AED CHECK: (located West Wing Floor 1 Same Day Care Clinic, West Wing Floor 2 Hallway, East Wing Pharmacy, East Wing Floor 2 CAPS)

PROCEDURE:  See AED Policy link


Effective Date: 
Sat, 04/01/2006
Fri, 08/19/2011
Fri, 08/26/2011

Work assignments and hours of work are set by supervisors based on the operational needs of the Student Health Center. Providing health care to patients is a team based activity, and lateness in arriving or early departure may mean colleagues and coworkers are without important support and collaboration in discharging their duties and providing health services. Because of this, staff are expected to make every effort to be in their work area and available to carry out their work function at the assigned time.


Departmental hours of operation are set by supervisors in collaboration with the Management Team and approved by the Executive Director. Departmental hours are determined by considering the operational needs of the unit in the overall context of the multi-department process of providing health services to students.

Departmental hours and hours of work for individual staff members are clearly communicated to the staff member by his/her supervisor. Any change or modification that requires union notice or approval is made in accordance with the specific collective bargaining agreement covering the employee involved, or with reasonable notice and according to university policy for unrepresented staff.

Repeated lateness or unavailability of a staff member in his/her work area during hours of work is considered a performance issue and will be addressed by the supervisor in accord with policies and procedures appropriate to the staff member’s position and bargaining unit.

Key Points: 
  • Departmental hours of operation are set by supervisors based on the operational needs of the health center, in collaboration with the Management Team, and approved by the Executive Director.
  • Departmental hours and hours of work for individual staff members are clearly communicated to the staff member by his/her supervisor.
  • Because providing health care to patients is a team based activity, staff are expected to make every effort to be in their work area and available to carry out their work function at their assigned time


Effective Date: 
Sun, 09/15/1996
Fri, 04/13/2018
Fri, 04/13/2018

The SHC adheres to UCSC Risk Services policies on workers compensation for UCSC employess.  UCSC Employees presenting to the SHC for work related illness or injury will be provided first aid, comfort and information on accessing services at the UCSC contracted provider of Occupational Health services off campus. UCSC Risk Services is responsible for training UCSC supervisors to assist and authorize their employees with occupational illness or injury to proceed with a timely evaluation at the contracted Occupational Health provider for UCSC or Dominican Hospital ER (DSCH) depending on the acuity and time of day. In cases where UCSC employees present to the Student Health Center seeking care of occupational illness or injury the following procedure will be followed:

  • If UCSC employees present to the Student Health Center for non-emergent care of occupational illness or injury the reception staff will provide information (see Workers Comp reference found in EMR - References - Infrequent P&Ps) on campus procedures for Workers Compensation care.  Unless there is an apparent emergency or need for immediate attention, the employee will be re-directed back to their supervisor for care at the UCSC contracted Occupational Health provider (see UCSC Risk Services link).  Assistance with transportation, if necessary, will be offered via arranging for taxi service and provision of taxi voucher. In some cases, the employee’s supervisor may choose to provide transportation.
  • If the employee presents with an obvious emergency, or if the employee feels unable to travel to the Occupational Health provider for care, the employee will be signed into Same Day Clinic and evaluated by the Triage nurse. If there is any question regarding the safety of the employee traveling for care the employee should be signed into Same Day Clinic for evaluation by the Triage nurse.
  • If a student with UC SHIP or Cruz Care presents with a simple illness or injury and no further follow up will be needed and no labs, supplies or medication is required, the student can be seen at the Student Health Center. (Rationale: If it is an illness and injury visit only, there is no charge to the student, the SHS absorbs this cost and does not bill insurance.)"
The Triage nurse will assess the patient and proceed as follows:
  • Emergent cases or cases in which immediate care is needed:
    These patients are seen by the Same Day Clinic clinical staff. After stabilizing the patient ambulance or other transport to DSCH ER is arranged as appropriate. In less emergent cases such as active bleeding from minor wounds or chemical burns to eye immediate care is provided before arranging appropriate transport to the contracted Occupational Health provider or DSCH ER for further evaluation and treatment.  A "Doctors First Report of Injury" form will be completed by the treating clinician (see attached weblink)
  • Other cases, including minor problems requiring only First Aid (see definition below):
    Patients who are evaluated by the triage nurse and then found to need only information, referral or first aid may be cared for by nursing staff. Patient may be discharged directly to follow up at the contracted Occupational Health provider.
First Aid:Definition of First Aid chart reprinted from UCSC Risk Management website:

“First aid means any one-time treatment of minor scratches, cuts, burns, splinters or other minor work injury."

  • All follow-up care is to be rendered through the Occupational Health provider or the patient’s designated medical provider for workers compensation care. All follow-up instructions should direct patients to the contracted Occupational Health provider rather than return to the Student Health Center.
Documentation of clinical care:
  • Refer to Workers Comp Process located in Internal References in EMR that details procedures.
  • Use workers compensation template in EMR for documentation of assistance and first aid
  • Triage nurses will make an entry in the medical record for any patient evaluated, particularly if providing first aid care.
  • When workers compensation patients are seen by a clinician at the Student Health Center the Doctor’s First Report is to be completed by treating clinician, and a SHC referral form advising receiving or follow up facility of care provided at Student Health Center.
Workers Compensation paperwork for all employees seen by the Student Health Center.
  • Receptionist
1. Checks the patient in to Triage using UC Same Day visit type and Workers Comp reason code
2.  Assists the patient in contacting their supervisor
3. Attaches a copy of the "SHC Workers' comp Checklist and a printed copy of the web link Workers Comp. – Injury Reporting & Medical Treatment to their red out guide.
4. Places paperwork and chart in red outguide folder
  • Nurse/Clinician

1.  If first aid was all that was required the employee is then sent back to their supervisor.


 If any treatment beyond first aid is needed emergently Student Health Services provides this service and fill out Worker’s Comp – First Report of Injury located in Web links (print hard copy and submit as indicated on top of form). A copy of this form should be scanned in to the EMR. 

2. If not already done, assist the employee in contacting their supervisor to facilitate the next steps with Occupational Health (see link to Risk Services). If the employee is unable to contact their supervisor due to an emergent medical condition SHS will alert the employee’s supervisor.

3.  If a student with UC SHIP or Cruz Care presents with a simple illness or injury and no further follow up will be needed and no labs, supplies or medication is required, the student can be seen at the Student Health Center. (Rationale: If it is an illness and injury visit only, there is no charge to the student, the SHS absorbs this cost and does not bill insurance.)

Workers Compensation for Student Health Center staff
Occupational illness or injury in SHC staff is handled in the same way as it is for other university employees. Supervisors, upon notification of the illness or injury, will complete required documentation per campus Risk Services policies. Staff members will leave work and travel to the contracted Occupational Health provider to seek care. A Student Health Center Opportunity for Improvement report should also be completed.
For needle sticks or other bloodborne exposures/injuries see the Sharps Injury Policy.


Effective Date: 
Sun, 09/15/1996
Mon, 08/22/2011
Mon, 09/18/2017

The SHC adheres to UCSC Risk Services policy on workers compensation. The SHC does not provide workers compensation care for UCSC employees. (see Worker's Comp Process for UCSC employees located in internal references in EMR).  Occasionally, UCSC students eligible for SHC services and employed off campus (non UCSC employment) will present to the SHC for work related injury or illness assistance.

Many employers have a contracted Workers Compensation occupational health clinic where employees should preferably have their initial assessment.  The SHC will assist the UCSC student in contacting their employer to determine the appropriate care provider for their work-related injury. 

It is always appropriate to give immediate first aid to injured workers and not delay care while the employer is being contacted for further information. 
If the employer identifies another provider for injured workers, the role of the Student Health Center is to facilitate the transfer of care to the designated provider. If a student chooses to decline their employer designated workers compensation provider, they will be informed that they may be responsible for more costs stemming from the work related injury or illness.  After informing the student of their options and potential costs, the student may be seen for medical evaluation at the SHC like any other eligible student seen for non work related injury or illness. Students may prefer the convenience of care at the SHC even if it results in more out of pocket costs than if they had gone through their employer's workers compensation process and designated provider.


When an eligible UCSC student presents with a non-UCSC work-related injury, the clinician or designee contacts the employer for direction on which facility is authorized to provider workers compensation evaluations. If the employer is unavailable and or the patient condition is acute, care is initiated at the SHC and not delayed while awaiting response from the employer.
If the employer authorizes treatment at the Student Health Center, care is delivered. The clinician completes a Doctor’s First Report of Occupational Injury or Illness and distributes the report according to the instructions at the top of the form.  A copy is scanned into the EMR.  This may or may not be the current form in use and is not use for UCSC staff.
If care is initiated at the Student Health Center and follow up care is to be continued by the employer’s Workers Compensation provider, the clinician completes a Doctor’s First Report of Occupational Injury or Illness and distributes according to the instructions at the top of the form.


Effective Date: 
Mon, 07/15/1996
Fri, 05/15/2015
Thu, 03/30/2017
The Student Health Center provides medical services and psychological services to survivors of sexual assault.
The SHC does not perform forensic examinations and does not collect specimens for prosecution of a crime.
For patients who desire a forensic exam the SHS facilitates contact with the police department which has jurisdiction over the place in which the assault occurred and the police arrange a SANE exam.  
As soon as an assault is identified the patient is offerred an advocate for support.  Advocate contact information is listed in the Sexual Assault Survivor Management reference in the EMR (HC933).
Clinicians are to follow this reference to assure that thorough and comprehensive care is offered.
Medical care includes a complete physical evaluation and care for any injuries as well as emergency contraception, STI screening and treatment.  Medical providers comply with the state mandated requirement to report Violent Injury. Phone numbers for police dispatch, phone numbers for on-campus Sexual Assault Crisis Counselors on campus and Violent injury report forms are found in the Electronic Medical Record under Internal References.
Clinicians and nurses at SHS refer survivors of sexual assault to Counseling and Psychological Services (CAPPS) for psychological assistance and to off campus providers as appropriate.
  1. Patient discloses that s/he has been sexually assaulted.
  2. Charge nurse determines the clinician most appropriate for visit and arranges clinician schedule to accommodate the visit.  If clinician elicits this information in a visit an attempt is made to revise schedules to allow the clinician and the patient more time for the visit. 
  3. Staff work to limit the number of people from the SHS involved to maintain privacy.
  4. Clinician meets with patient and collects information.  It is critical to identify the time, date, and place of the event.  
  5. Clinician explains the option of a forensic examination.   If the patient desires forensic examination, the clinician calls UCSC non-urgent police line at 459-2231.  UCSC police will need to know the location where the incident occurred.    The police arrange a forensic exam.  The location of the event determines what police department is responsible for taking the report and arranging the forensic examination. For off-campus incidents, UCSC police will link the clinician to the appropriate police department.  Once a jurisdiction has been determined, if it is not on campus, UCSC police must defer management to the police of jurisdiction.
  6. If the patient is going to have a SANE exam, do not examine them.  Do not touch them.  Do not ask a lot of questions.  Facilitate transfer to a location where appropriate exam can take place.
  7. As soon as possible in this process identify someone who can be the patient's advocate.  It is important to have the patient supported by someone who is not a clinician and not police.  A list of state certified sexual assault crisis counselors on and off campus is kept in Internal References.
  8. Assess for acute injuries - do a whole body review. 
  9. Prevent STIs.  There is a web link in the EMR to the CDC STD Guidelines.  These guidelines provide the most up-to-date guidance on prevention of STIs for survivors of sexual assault.
  10. Provide emergency contraception.
  11. Inform the patient that the clinician is required by law to report the incident.  Make clear that the patient may chose to disclose or not disclose any information to the police.  Note the patient preference for talking to police on the Violent Injury Report form.  Give patient the required  pamphlet "Resources and Options:  Sexual Harassment, Sexual Assault, Dating & Domestic Violence, Stalking & Other Prohibited Conduct". (See attached)
  12. The clinician or designee telephones Campus Police and completes and faxes form HC: 433 within 24 hours of the visit.
  13. Patient is given resources for emotional support and a follow up visit with clinician if indicated.
  14. Immediate crisis counseling services are available through CAPs and should be offered to the patient.
Key Points: 

Sexual assault is a serious crime and survivors should receive appropriate information about their right to seek legal action against their assailant.   Survivors who wish to pursue legal action are referred to the police for formal forensic evaluation by a Sexual Assault Nurse Examiner.  THis service is not available at the SHS

Sexual assault survivors need physical examination, prevention of STIs and pregnancy, and emotional support.  The SHS is prepared to provide these services to survivors who choose not to pursue legal action.

Clinicians are responsible for Mandatory reporting of Violent Crime, including sexual assault.  These reports must be submitted within 24 hours of the visit.

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