Main: (207) 973-7000 | Toll Free: (877) 366-3662 | 489 State Street, Bangor, ME 04401

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Clinical/Observational Experience at Eastern Maine Medical Center

  • Please review Item # 1 for identification of location and responsible party to send your completed forms to.
  • Review Item # 2 for required forms for each experience
  • Select the appropriate forms from the list below, complete and forward to the correct e-mail address or mail to the correct address.

The forms are available in both PDF and Word format. 

  • Please use the PDF forms if you prefer to print the forms, fill them out and send them to us via US Mail.
  • Please use the Word documents if you have Microsoft Office installed on your PC and wish to fill them out on your PC and email the documents to us.

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Application for Observational Experience    Word     PDF  
Code of Conduct                  PDF 
Dress Code for Future Health Care Observers   Word   PDF 
Evaluation for Non-EMMC Participants   Word   PDF 
Notice of Privacy Practices    PDF 
Orientation to Privacy, Confidentiality and Info Security      Word   PDF 
Orientation to Life Safety  Word   PDF 
Student Badge Request Form   Word   PDF 
       
 

 

Eastern Maine Medical Center