Cervical Smear Taker Training NZQA Standard 29556 Entry to the Cervical Screening Training is restricted to individuals who meet the following criteria: 1. The applicant is a registered health professional whose scope of practice includes cervical screening such as Medical Practitioner, Nurse Practitioner, Registered or Enrolled Nurse, Midwife. 2. You must have a current New Zealand Practising Certificate. 3. Possess professional/personal indemnity insurance. 4. Have access to an appropriate client base and have ongoing numbers of women who require cervical screening to ensure competency can be maintained. 5. Be supported by a clinical supervisor (during your training) to complete the clinical component of the course.
Application Form (All fields are compulsory) Course Date: ____________________ Location: __________________________________ Full Name:
______________________________________________________________
Ethnicity:
___________________________
Cell: Ph
_________________________ Email:______________________________
Date of Birth: ____________________
Workplace Name and Address ______________________________________________________________________________ ____________________________________________________________________________________ Work Phone:
__________________________
Main area of practice: Registered Nurse Enrolled Nurse
Work email: ________________________________
Midwife Medical Practitioner
Nurse Practitioner
Practicing Certificate #: ……………………………..
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Indemnity Insurance #………………………….
Supervising Smear Taker
Supervision Your supervisor(s) can be a person(s) nominated by you and will provide mentoring, support and clinical advice. They must have a current NCSP Register ID number and be currently involved in Cervical Screening. They must have a current practicing certificate as a Registered Nurse, Nurse Practitioner, Midwife, or Medical Doctor. Preferably they should have a minimum of two years practice in sample taking. Your supervisor must be in the room with you for at least the first 15 smears that you take and sign and complete part two of the consultation checklist
Name:
____________________________ Qualification: ______________________________
I agree to support and supervise ________________________________ for their first 15 cervical smear tests as part of their training as a cervical smear taker. __________________________________ Signature
_____________________ Date
Any special needs (learning, disability, dietary, cultural) we should know about? _________________________________________________________________________ __________________________________________________________________________ NB: Morning tea provided I agree/do not agree to Well Women and Family Trust emailing me regarding Well Women and Family Trust courses and updates. I agree/do not agree to allow Well Women and Family Trust to give out my details to relevant health authorities who request information about my smear taker training.
__________________________________ Signature Applicant
_____________________ Date
For any enquiries please call 09 846 7886 or email admin@wons.org.nz
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