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  1. University of Arkansas for Medical Sciences
  2. College of Medicine
  3. Department of Anesthesiology
  4. CRNA
  5. CRNA Shadowing Guidelines and Form

CRNA Shadowing Guidelines and Form

* designates required fields

"*" indicates required fields

Thank you for your interest in shadowing a UAMS CRNA!

CRNA Shadowing is available to nurses who are in the process of applying or have already applied to a nurse anesthetist program and meet the required 1-2 years of working experience in a critical care ICU. Shadow dates are held on Tuesdays and begin with the CRNA’s first case of the morning. Shadowing is only permitted in areas where the CRNA is assigned active cases. UAMS CRNAs do not provide care for cardiac or obstetric cases. Individuals are limited to one shadow day each calendar year.

Do not click submit if all fields have not been completed. Edits cannot be made once the request has been submitted. Incomplete requests will not be eligible for shadowing.

Name * Required
Email * Required
Individuals allowed in patient care areas, including the operating suite, must meet at least ONE of the conditions listed below. Once a response is selected, the corresponding submission form will auto populate.
• Do you hold current licensure or certification as a medical or health care professional? * Required
• Are you currently enrolled in a medical or health care professional degree program; or are you affiliated with a UAMS student health care program? * Required
• Do you have 1-2 years of working experience in a critical care ICU? * Required

Important:

This program is available only for nurses who meet application requirements. Application to most CRNA programs requires one to two years of critical care experience.
• Are you a representative through employment with a company or agency that holds current interest in a specific patient care activity? (e.g. sales representative) * Required
Are you a UAMS employee or student? * Required
You must follow all THREE steps below and submit the requested documentation for your application be considered complete and to be scheduled for review. Please allow 1-2 weeks after your submission to receive notification of an approved shadowing date. Once all of this information has been received you will receive an email with confirmation details for your shadowing date.
If you are a non-UAMS employee/student and meet one or more of the above criteria, please submit the documentation below for your shadowing application to be scheduled.
  1. Complete and sign these two forms: Request to Shadow and Confidentiality Statement.
  2. DO NOT submit your immunization records here. Send a copy of your immunizations, along with flu shot documentation if during flu season, to UAMS Student and Employee Health with a message that you are requesting to shadow a CRNA in the operating room. They will send you an email once they have confirmed that you are compliant with UAMS immunization requirements. DO NOT submit your immunization records here. Save the confirmation email from UAMS Student and Employee Health as a PDF or screenshot and upload it with your other documents below.
  3. UAMS HIPAA Required Privacy & Security training module – below is the link to this module. This module cannot be completed on a mobile device such as an iPad, cell phone or tablet. Although a mobile device will load the training, it will not allow you to submit the completion page at the end that gives you credit for this training module. Please make sure that your pop-up blocker is disabled. Please contact the UAMS HIPAA Office at 501-603-1379 for any assistance or questions. Once you have completed this module, save the confirmation page as a PDF or screenshot and upload it below along with the rest of your information. Access the HIPAA training module
You must follow all THREE steps below and submit the requested documentation for your application be considered complete and to be scheduled for review. Please allow 1-2 weeks after your submission to receive notification of an approved shadowing date. Once all of this information has been received (and your requested date has been approved) you will receive an email with confirmation details for your shadowing date.
If you are a UAMS employee/student (and meet one or more of the above criteria) please submit the documentation below for your shadowing application to be scheduled.
  1. Complete and sign these two forms: Request to Shadow and Confidentiality Statement.
  2. DO NOT upload your immunization records here. Send a copy of your immunizations, along with flu shot documentation if during flu season, to UAMS Student and Employee Health with a message that you are requesting to shadow a CRNA in the operating room. They will send you an email once they have confirmed that you are compliant with UAMS immunization requirements. DO NOT submit your immunization records here. Save the confirmation email from UAMS Student and Employee Health as a PDF or screenshot and upload it with your other documents below.
  3. UAMS HIPAA Required Privacy & Security training module – To retrieve your HIPAA compliance certificate, log into Workday and save a copy of the certificate to attach below. Please contact the UAMS HIPAA Office at 501-603-1379 for any assistance or questions.
Upload your signed Request to Shadow form here.
Max. file size: 15 MB.
Upload your signed Confidentiality Statement form here.
Max. file size: 15 MB.
Upload a PDF or screenshot of your email from Student and Employee Health here. DO NOT submit your immunization records here.
Max. file size: 15 MB.
Upload a PDF or screenshot of your email from Student and Employee Health here. Note, this is only required during flu season.
Max. file size: 15 MB.
Upload a scan or clear picture of your COVID vaccination card.
Max. file size: 15 MB.
Upload a PDF or screenshot of your HIPAA training confirmation page here.
Max. file size: 15 MB.
Do not click submit if all fields have not been completed. Edits cannot be made once the request has been submitted. Incomplete requests will not be eligible for shadowing.
This field is for validation purposes and should be left unchanged.
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Mailing Address: 4301 West Markham Street, Little Rock, AR 72205
Phone: (501) 686-7000
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