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Medical Students

PLEASE NOTE NEW INFORMATION
Effective 10/1/2013, once a rotation is scheduled or approved, the following forms and information must be received by the Site/Department Student Coordinator a minimum of FOUR (4) weeks prior to the rotation start date.  Information can be submitted via e-mail, fax or postal service to the rotating location (See Site Specific Information).  Students must follow-up with the Coordinator to ensure paperwork has been received and processed. 

ROTATIONS WILL BE CANCELLED IF FORMS AND INFORMATION ARE NOT COMPLETE AND APPROVED A MINIMUM OF FOUR (4) WEEKS PRIOR TO THE START OF THE ROTATION.

Forms

  • Medical Student Information Form

    • Must be completed for EVERY rotation scheduled at an Advocate Hospital/Medical Center or AMG office.

  • Medical and Immunization 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.

    • TB Surveillance -TB test documentation must be current within one (1) calendar year of the rotation start date.  If your TB test will expire during your rotation you are required to get an updated test prior to the rotation start date.

      If you're current TB test is positive or you have had a positive TB test in the past, proof of a negative chest x-ray or medical clearance/proof of treatment is required.  CXR results are valid until the student indicates positive signs and symptoms per the annual screening questionnaire (described below)

      Also, if you had a positive TB test in the past, an Advocate screening questionnaire must be completed annually, within one year of your scheduled rotation (Form listed below).  

    • Every student, rotating on a clinical service, must be fit tested for a Technol N-95 TB mask. The date of testing and size of mask must be indicated on the Medical and Immunization Clearance Form.

    • Every student who rotates at an Advocate site must provide proof of Flu vaccination. Flu vaccination is required for all rotations occurring between 10/1 and 4/30 each year.

    • The student is required to sign the form to verify the accuracy of the information.
  • TB Questionnaire (as applicable)

  • Access Form

    • Care Connection/Confidentiality Form

Required Information

  • Letter of Good Standing --- Required only for students on elective rotations from a non-affiliated medical school. Must verify student academic status, the medical schools approval/authorization of the named elective and the student evaluation requirements. Also must include verification or documentation of criminal background check, OSHA and HIPAA education. The letter must be on University/Medical School stationery and be signed by the Office of Student Affairs.

  • Evidence of completed Criminal Background check- supplied by the university/medical school to Medical Student Coordinator

  • Evidence/verification of OSHA/Universal Precautions Training--supplied by the university/medical school to the Medical Student Coordinator

  • Evidence/verification of HIPAA training--supplied by the university/medical school to the Medical Student Coordinator

  • Proof of BLS/CPR certification
  • Verification of student health insurance coverage (non-affiliated students only)

  • Documentation of malpractice/liability insurance in the required amounts of $1 million per occurrence/$3 million aggregate (non-affiliated students only)


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