By checking the box for each document , , does hereby certify that the following documents are on file at the contracted college office, or were completed online, for themselves and/or ALL students in the clinical rotation group. ALL faculty and students must complete online registration at least 15 days prior to their rotation start date. Failure to complete registration before the start date may result in a delay in start of the entire group’s rotation. ALL faculty and students must complete requirements to proceed. By completing this page, you are certifying that all of the following documents are on file for yourself and each student in the clinical rotation group. This information will also be matched with each student’s individual registration information. For questions, please contact the Student Programs Department at email@example.com
Background Check Results(same criteria as Kindred Healthcare HR policy)
Drug Screening Verification(standard 5 panel screen)
PPD or CXR Negative Test Results
Hepatitis B Vaccination Declination/Consent (Titer)
Influenza Vaccination (flu shot seasonal)
Tdap (one time administration) or Tetanus
Patient Confidentiality Agreement
*If you are unable to attest to any of the above or do not have these records on file at the college, please explain below.
* If you have any questions regarding the above requirements, please contact the Student Program Department at 800-677-1202 ext 2646.