Homestead Simulation Hospital: SCE, Reservation Dates and Supplies Request Form

Homestead Simulation Hospital

Simulated Clinical Experience, Reservation Dates and Supplies Request Form

Our staff will get back to you within 48 hours to confirm your reservation or to re-schedule if the dates are not available

Request Reservation Day: (Month/Date/Year)*

Available Timeframes*

8am - 12pm 1pm - 5pm

Faculty Name*

First Name

Last Name

Simulation Type*

Office phone Number*

Cell phone Number

Email*

Class Name*

Class Reference Number*

Number of Students in your class*

Purpose*

Clinical: Critical Thinking Testing: Critical Thinking

Simulator Needed*

Adult Pediatric Infant OB

Please select your desired scenario category. Then, select the corresponding clinical scenario from the drop down menu below.

Note:*

We kindly request Faculty to please not change the selected scenario in the morning of the day of your reservation. Your consideration is much appreciated.

One medical supply kit per student group for one human patient simulator. Supplies and Equipment will be supplied as available. Please arrive 5 minutes early before your reservation start time to review the supplies and equipment provided to you.

Medications IV start kit Foley Kit Nasogastric Tubing Emergency Crash Cart

Additional comments

Note:*

Once you submit your request, PLEASE WAIT to receive an email CONFIRMATION from our end or to please RESCHEDULE. Thank you for your cooperation.