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RU/RUC Non-Nursing Discipline Geriatric Home Health Simulation Request

Name Of Requestor:

Phone Number:

Email:

Date(s) Requested:

Simulation Center Site Preference:

Cook Hall, RU Main Campus
Roanoke Higher Education Center

Learner Group Description:

Department: (A fee may apply to external users outside of the School of Nursing)
Level:
Course Number:

Number of Learners:

Preprogrammed CSC Scenarios Choice(s):

Gero 1: Home visit after hospitalization for poorly controlled diabetes
Gero 2: Second home visit of same patient in Gero 1
Gero Combo: An unfolding case study combining Gero 1 & 2
Gero 3: Different patient home visit, follow up Hospice visit of surviving spouse
Other:

What course objective(s) does this simulation address? (Copy and paste objective(s) below)

What program objective(s) does this simulation address? (Copy and paste objective(s) below)

Audio Visual Needs:

Live Viewing
Recording & Playback Capability
None Needed

Will you be sending faculty to conduct/view the simulation and debriefing?

Yes
No
Maybe

Do you have your requested simulation activity already designed and programmed(if not using a CSC preprogrammed simulation)?

Yes
No
Requesting design and/or programming assistance from CSC faculty

Please indicate several dates and times you are available to meet with the Director, Simulation Faculty, and/or Program Manager to discuss details of your request. Include ability to meet in person at the center or virtually.