Medical Students

Once a rotation is scheduled or approved, the following forms and information must be received by the Department Student Coordinator a minimum of two (2) 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 two (2) 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

• 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.

  • Rotating Residents - TB documentation must be current within 1 calendar year. Positive TB test requires proof of negative chest x-ray (valid for 2 calendar years), medical clearance or screening questionnaire (valid for 1 calendar year).

  • Medical Students - If TB test expires during rotation, an updated test prior to the rotation start date is required. Positive TB test requires proof of negative chest x-ray (valid for 2 calendar years), medical clearance or screening questionnaire (valid for 1 calendar year).

  • Every student, rotating on a clinical service, must be fit tested for a TB mask. The date and type of mask must be indicated on the medical clearance form.

  • 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

• 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)