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Medical Student Office
1775 West Dempster Street, 6 South
Park Ridge, Illinois 60068


Required Forms:

Once a rotation is scheduled or approved, the following forms and information must be received by the Medical Student Office a minimum of four (4) weeks prior to the rotation start date. Information can be submitted via e-mail, fax, or postal service. Students must follow-up with the Coordinator to ensure paperwork has been received.

Rotation Paperwork Check Lists

RFUMS, U of I-Chicago, and

All other students:

  • Medical Student Information Form
  • Confidentiality Agreement
  • TB Questionnaire (positive PPD/QFT only)
  • Medical Student Information Form
  • Medical and Immunization Clearance Form
  • Confidentiality Agreement
  • Letter of Good Standing


Forms and Instructions:

Medical Student Information Form

  • Must be completed for EVERY rotation scheduled at an Advocate Hospital/Medical Center

Medical and Immunization Clearance Form

  • TB Test – If TB test expires during a scheduled rotation, an updated test is required prior to the rotation start date. Positive TB test (>9) requires proof of negative chest x-ray (must be dated after positive TB test) and TB Questionnaire (must be completed for every rotation).
  • Mask Fit Test - Every student rotating on a clinical service must be fit tested for a Technol N-95 TB mask. The test date and mask size must be indicated on the medical clearance form.
  • Vaccination/Immunity Status - Student must indicate the date of the immunity titer and circle the result. If no titer, please indicate vaccination dates as listed.
  • Flu Vaccine – Students are required to be vaccinated for the current flu season for the rotation start dates from October 1 – April 30.
  • Students are required to sign the form to verify the accuracy of the information. 

Confidentiality Agreement

Letter of Good Standing

  • Must be on University/Medical School stationery and be signed by the Office of Student Affairs.
  • Must verify student academic status, the medical school’s approval/authorization of the named elective and rotation dates, and the student evaluation requirements.
  • Must include verification of the following (or separate/attached documentation:
    • Criminal Background check
    • OSHA/Universal Precautions training
    • HIPAA training
    • BLS/CPR training
    • Student health insurance coverage
    • Malpractice/liability insurance in the required minimum amounts of $1 million per occurrence/$3 million aggregate

Please print, review and bring your rotation expectations with you on the day of orientation (see below).
Rotation Expectations Program Specialist Phone Fax
Family Medicine Clerkship Danielle Priester
847.723.6464 847.723.5029
Internal Medicine Clerkship
OB/Gyne Clerkship
Pediatrics Clerkships
Psychiatry Clerkship
Surgery Clerkship
Internal Medicine Sub-I
Emergency Medicine Elective Tara Murphy
847.723.6479 847.723.5029

Family Medicine Elective

Internal Medicine Elective
OB/Gyne Elective
Pediatrics Elective
Psychiatry Elective
Radiology Elective
Surgery Elective
***Electives offered at Advocate Lutheran General Hospital***


Parking Information:

All medical students must park in the open surface lot on the north side of Dempster Street at the Luther Lane traffic light. Public Safety will remotely open the gate to the North Garage when the surface lot is full. If you are not able to find parking and the North Garage is not open, you should be able to find parking near the water tower on the west end of the surface lot and/or the gravel lot on the far east end.

*Students are not permitted to park in the garages in front of or next to the hospital. These areas are designated for patients, and parking there may result in a parking citation or dismissal from your clinical rotation.

Parking Registration:

Upon submitting rotation paperwork, your vehicle’s license plate number will be registered with the Public Safety Office. Any changes to your license plate number must also be registered with Public Safety.

Medical students with registered vehicles will receive parking placards for the designated parking lot during orientation and must display them in their vehicles.

Directions to the Medical Student Office:

  1. Enter the hospital through the Parkside building entrance.
  2. You will go left and continue on that hallway.
  3. At the end of the hallway, turn left and walk past the A Elevators and the information desk.
  4. Look for signs for the C and S Elevators.
  5. Walk past the C Elevators and follow the signs to the S Elevators.
  6. Take the elevator to the 6th floor.
  7. Exit the elevator and walk past the small reception area.
  8. Go through the entrance and make a quick right (the Medical Student Office is around the corner).
  9. Upon arrival, please have a seat until we announce the start of your orientation.

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