Affiliate Hospital Forms
Health Requirements and Immunization Guide Heading link
All students should have the requirements (listed in the health requirements and immunization guide) on file in CastleBranch.
Forms required by affiliate hospital sites Heading link
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Advocate Health Care Sites: Christ, Illinois Masonic, Lutheran General
Students will receive an email from MedHub approximately two months prior to the start of their rotation with assigned tasks. Students will have approximately four weeks to complete, similar to when students completed via email. The beauty of MedHub is that students will not need to complete the entire set of assignments for each rotation. They will only need to make updates if requested by the site coordinator. It is possible that the email from MedHub may go to spam.
In addition, we have updated the N95 masks that we allow. Below are the approved N95 mask models:
- 3M Aura 1870+
- 3M Vflex1804S
- Halyard N95, Small
Students can get tested for a fee thru Advocate Occupational Health if they are unable to get tested thru their school. Students rotating in EM and Trauma must be tested. Students coming for other rotations that are not fitted for one of the above models, will need to recuse themselves from all patient encounters that require a N95. Attached are the instructions for scheduling a fit testing thru Advocate Occupational Health.
- Medical Student Information
- Medical Student Forms and Requirements
- Advocate Coordinator Information
Advocate Health Care Forms
Every student, rotating at an Advocate hospital for 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. At Advocate Christ a copy of your respirator fit form is mandated. In addition, your TB cannot expire while on this service. You may request a copy of your scanned student health information by submitting the ‘Student Request Form’. Your records will be sent to you via the secure PEAR application.
Form requirements for Medical Students
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Hartgrove Hospital
- Student Forms
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John H. Stroger, Jr. Hospital of Cook County
- Student Forms
- Returning After One Year Required Documents
- Returning Students Within One Year Requirements (No Documents Needed)
- Student Forms
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Jesse Brown Veterans Administration Medical Center (JBVA MC)
Administrative Process
Required Release Form
Students scheduled at the VA have special requirements:
*Note: Students with an expired VA ID badge may extend their authorization by submitting this one-page WOC Agreement where they have written-in their expected graduation year on line two of the first paragraph
All medical students must complete the VA online onboarding process six weeks prior to your rotation with the VA.
- the WOC (Without Compensation) Packet;
- the Special Agreement Check (SAC) and
- the Declaration for Federal Employment
You must also provide a copy of
- your US Passport or drivers license or state ID;
- a copy of your birth certificate or Social Security card or voter registration must also be included with the packet.If foreign born but is a US citizen, student is required to include a copy of their US Passport or a copy of their Naturalization certificate. If a non-citizen, student is required to include a copy of their Visa info, etc. to include any other documents that give them authority to be in the US as a studentOnline SF-85 (e-QIP)All students scheduled at the VA must complete an online SF-85 (e-QIP) and meet with a Human Resources staff member at Jesse Brown Veterans Administration Medical Center before reporting to the scheduled clinical activity there. After you received notification that your WOC appointment has been approved, here are the administrative procedures that you should follow:
- WOC appointments that are over six months will need to complete an online SF-85 (e-QIP), which can be accessed through at the Defense Counterintelligence and Security Agency website. This link can be accessed on any computer with internet. Human Resources is no longer accepting handwritten investigations (SF-85), all must be done electronically. Once you have completed the questionnaire online, you will be given the opportunity to print an archival copy for the record and two (2) signature pages. You will need to bring these signature pages with you for processing.
- Please make sure that you read the Electronic Questionnaire for Investigations Processing (e-QIP) brochure brochure attached with your approval notification to complete the security investigation on-line within 3 days business days of receiving this e-mail. If not completed within 45 days period your access will be suspended with e-quip. In the brochure, you will find detailed instructions on how to access this program. Should you have any questions, please feel free to contact me.
- Appointment with Human Resources Office – An appointment is mandated for your administrative process in Human Resources staff. Please do not just show up without calling first. Please contact chs_trainee@va.gov.
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University of Illinois Hospital
- Instructions for PowerChart & HIPAA Training via Learning Management System(LMS)
- Scrub Suit Policy , required for clinical experiences in Anesthesiology, Otolaryngology, Neurosurgery, Ob/Gyne, Ophthalmology, Orthopaedics, Surgery Clerkship/Electives/Sub Specialties, Urology
- Scrub Suit Form
- UIH ID Badge
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