Welcome! This page is designed to provide nursing students and instructors with security forms required to access Memorial Hospital's EMR (Electronic Medical Record).
All forms need to be submitted to Memorial at least three weeks prior to the student's clinical start date. Failure to do so may lead to delayed access and inability to electronically document patient care. Please contact Barb Phelps, Nursing Educator, at 574- 647-7228 for more information.
Required Forms: Submit to Memorial at least three weeks prior to student's clinical start date
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Nursing Schools Activity Worksheet (XLS)
Instructors, please download and complete the Nursing School Activity Worksheet. Remember to provide all required fields in their entirety (including the last four digits of the SSN and full birth date). Please email the completed Nursing School Activity Worksheet to Memorial's Information Systems Security Team (InformationSecurity@memorialsb.org).
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Confidentiality and Non-Disclosure Agreement (DOC)
Each student and instructor must print and sign the Confidentiality and Non-Disclosure Agreement.
The Confidentiality and Non-Disclosure Agreement may be faxed to 574-647-3062.