Student requirements for Clinical Placement Health: o o o o o MMR vaccination dates or titer Hep B all 3 doses or decline signed

TB skin test current within the year and will not expire during rotation History of Varicella: confirmed by physician record Health insurance card

Criminal Background Check: o Notification from academic facility that student has cleared background check or copy of notification(some facilities will no release document) Criminal background check could come from previous employment if they are willing to send a note indicating person has cleared background check within 2 years If CCHC needs to get criminal background check, then student has to come to HR with two forms of ID one of which is a picture, pay $15 in check, and have the background check run by CCHC takes 2-4 weeks.

Confidentiality form signed Contract and Liability from academic facility Orientation: Completion of mandatory and clinical mandatory packet or Day one of orientation

All information is to be emailed to cbrennan@capecodhealth.org or esaunders@capecodhealth.org or faxed to 508-862-7023 at least two weeks prior to the start of the clinical rotation-If student requires background check allow 4 weeks for clearance.

Revised 5/11cab revised 11/11