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Mandated Hospital Forms

 

Mandated Hospital Forms

updated October, 2009

Facility Mandated Health Certification Forms Required Administrative Forms / Additional information
Advocate Christ Hospital Medical Center

Advocate Lutheran General Hospital

Advocate Illinois Masonic Medical Center

 

 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 fir form is mandated.     In addition, your TB cannot expire while on this service. You may retrieve your health records from Student Affairs  Room 112 or Room 120 CMW or send a mailing address.  For security reasons, we longer email student records. 

Form requirements for Medical Students

www.advocatehealth.com >I am a health care professional>medical education>medical students>forms requirements

Great Lakes Naval Hospital Health Certification Required Release Form
John H. Stroger, Jr. Hospital of Cook County Health Certification
MacNeal Hospital See: Medical Student Rotation Requirements Medical Student Rotation Requirements
Psychiatry at Madden

Request for Release of Information (Illinois State Police)

Students scheduled in Psychiatry at Madden must complete/submit mandatory docouments at least four (4) weeks before the clerkships start date.

Jesse Brown Veterans Administration Medical Center (JBWSVA)  

ADMINISTRATIVE PROCESS:

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 theVA Form Packet 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 student

      Online 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 the following website:  http://www.opm.gov/e-qip/ 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 the Human Resources office at Jesse Brown Veterans Administrative Medical Center  x 569-7184 to schedule a date(s) to process this appointment.  WOC appointment(s) are not effective, ID cards will not be issued, and computer access will not be granted until the WOC appointee(s) have processed through Human Resources.  
St Joseph's Hospital of Chicago Health Certification Confidentiality/Information Security Policy is mandated.
Streamwood Behavioral Health System Medical Student Application and Release Form must be submitted to Student Affairs.
Children's Memorial Hospital Release Form (note only *4 students are scheduled in ENT at Children's)