Standardized Patient (SP) Request Form

Standardized Patient (SP) Request Form

Thank you for your interest in Standardized Patients (SPs) from the Stanford School of Medicine's Center for Immersive and Simulation-based Learning / Standardized Patient Program (CISL/SPP). Please note that the term SP is used for a variety of roles beyond that of a patient, including family member and interpreter. We are unable to provide SPs for any events outside of Stanford.

If you are looking for an ultrasound model, please fill out the US model request form: tinyurl.com/stanfordusmodel

If you are looking for a nurse confederate, please email details of your request to SP Program Director Karen Thomson Hall at kthall@stanford.edu.

NOTE: Due to the volume of events that we manage, the SP Program requires a minimum of a 12-WEEK LEAD TIME for a new or revised project or event (more time is always preferred); the specifics of the activity will determine the timeline for booking and training SPs.

If this is a repeat activity (previously held at Stanford) with NO changes from the last session, the lead time is a minimum of EIGHT WEEKS.

If you need an SP for physical exam practice or demo only, with NO case materials to learn, the lead time is a minimum of FOUR WEEKS.

IMPORTANT NOTE: The timelines above do NOT include holidays, and your request must be submitted 4, 8 or 12 weeks prior by 5pm PT in order for the SP Program to accommodate the request (for example, if your event is on a Thursday, the request must be received by 5pm on Thursday). More time is always preferred. If 4, 8 or 12 weeks prior to the event falls on a holiday, the request must be received on a WEEKDAY prior to the holiday. Please note that Stanford observes a 2-week Winter Closure, so if requesting SPs for an early-mid January event, you must add 2 weeks to the timeline.

There is a 4-hour minimum payment for onsite work, and a 2-hour minimum payment for virtual work, even if the SP is used for less time. There is a 2-week cancellation/change policy (cancellation OR changes must be requested at least 2 weeks before the event through Medscheduler), and the requester is responsible for covering sick leave if an SP calls out sick; see Agreement of Terms at the end of the form for additional details.

MASKING INFORMATION: We will follow whatever the current guidelines are (as set forth by Stanford Healthcare and Santa Clara County). If the guidelines change between the time of booking and the event, we will go with whichever guidelines are stricter. For example, if masks were required at time of booking the SPs, but are later made optional prior to the event, masks will still be required for the event.

Please fill out this form to request an SP and a member of the SP Program team will follow up with you within 5 business days. While we do our best to accommodate all requests, due to the multiple events that we run, we cannot guarantee it.

Event Name*

Date of Event (if known)

Event Start Time and End Time (if known)

Event Schedule (if known)

Brief description of event*

Goals of session / learning objectives*

Location of Event*

Number of learners (if known/applicable)

Requestor Name*

Department

Requestor Email*

Requestor Phone Number*

PTA Account Number or Hospital Cost Center Number*

We must have an account number before we can start making inquiries for booking. We are only able to process ONE PTA or cost center number.

PTA or Cost Center Approver Name*

PTA or Cost Center Approver Email Address*

Number of SPs requested (if known)

Demographics, if known (M/F, age, body type, etc)

Number of encounters per session (if known)

Length of each encounter (if known)

Is there a scenario/case for the SP(s) to learn?

Select or enter value

Will the SP be giving verbal or written feedback?

Select or enter value

Filming / Photography

Will the event be filmed / photographed?*

If you plan to film or photograph the SPs (or if you expect that your participants will), there are additional requirements that will be discussed in the consult.

Select or enter value

If yes, how will the video / photos be used?*

If filmed/photographed for outside use (including social media), we cannot use any of our SPs who are members of the Screen Actors Guild (they can do filming for in-house use only). Enter N/A if there will be no video/photo.

Photo/Filming Release Form

If you are taking photos or filming, we must have a copy of this form prior to making inquiries. Please note that your team will be responsible for collecting signed forms.

Drag and drop files here or

Agreement of Terms

* I understand that the SP Program requires a minimum of a 12-WEEK LEAD TIME for a new or revised project or event, an EIGHT-WEEK LEAD TIME for a repeat activity with NO changes, and a FOUR-WEEK LEAD TIME for physical exam practice only with NO case materials to learn.

* Weekday pay rate for AY25 is $32/hr for SPs and event proctors, and $40/hr for SPs working in a foreign language. If my project requires a contingent trainer or someone with a more advanced skill set, the pay rate is $40/hr. There is also an SU fringe benefit cost of 11.8% added to all wages (rate TBD for FY25). NOTE: Weekend and filming/video pay rates are more; please ask for details.

* Parking must be provided. The SP Program can purchase permits for on-campus events.

* There is a 4-hour minimum payment for onsite work, even if the SPs are used for less time.

* There is a 2-hour minimum payment for virtual work, even if the SPs are used for less time.

* If a shift is over 8 hours, there must be written approval of overtime. Pay for overtime is time and a half.

* Additional paid training time may be required depending on the project.

* Additional paid home memorization time may be required depending on the project.

* A PTA or cost center must be provided (or paid invoice) before any SP inquiries will be made.

* For a 3-4 hour shift, there must be a 15-min break in the middle of the shift per CA and Stanford labor laws. If the shift is longer than 6 hours, there must be a 30-minute meal break (unpaid) after 5 hours. An SP cannot work longer than 3 hours without a break or 6 hours without a meal break. An unpaid meal break may last no longer than one hour.

* The SP Program has a 2-week cancellation/change policy. If an SP has been booked for an event, and they are canceled with less than 2-weeks’ notice, the SP will be paid in full for the time contracted. The same is true if you reduce the hours of an SP with less than 2-weeks’ notice: for example, if you reduce the shift time from 6 hours to 4 hours less than 2 weeks before the event, the SP will still be paid for the originally booked 6 hours. The cancellation or change MUST be made through the Medscheduler website by going to ILC Reservations and submitting a change or cancellation form to change/remove the SP resource. An email does not count as official notice. If you are at the 2-week mark, the form must be received by noon (12 pm) to not be responsible for payment. Note: details of the event (number of SPs, case content, etc.) CANNOT be changed less than 2 weeks before the event.

* The SP Program cannot guarantee that an SP won't get sick. If you'd like to book a backup, the cost for a backup SP would be the same. If an SP calls out sick, the requester will be responsible for the cost of the sick leave (same amount as wages), charged to the PTA provided. If there's no backup SP, the SP Program will endeavor to find a replacement for the sick SP if requested, but cannot guarantee one will be found.

* SP Program and SP availability is dependent on other scheduled events and is not guaranteed.

Check this box to affirm that you agree to the terms above.*

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