Note: If you are a Medical Student - please find your needed documents here.
An affiliation agreement needs to be in place to go forward with a student placement for educational rotations. This can sometimes take some time. Please contact us as soon as possible to ensure an agreement is current and in place well in advance of an educational experience. This cannot be done by the individual departments and must be approved by the Student Affiliations department.
Paperwork, Documentation and Requirement Information for Rotations
Please review the attached documents that include the requirements for doing an educational rotation at Community Medical Center
Student Instructions and forms:
- Review Western MT Student Checklist/Orientation Manual (Read only)
- Parking Map for Students (Read only)
- RCCH Code of Conduct (Read only)
- Tobacco Free Policy (Read only)
- Background Check/Release Form (Print and return) Fill out Background Release Form in case we need to get a copy of the background check from the school for an audit or submit a copy of the background check with the Background Release Form. In some cases the school may not provide a background check for students. If this is the case, the student will be responsible for providing a criminal background check along with exclusion list checks from the national sexual offender registry search http://www.nsopw.gov/en-us Please check with your school contact to see if this is your responsibility to avoid delays in starting your student experience with Community Medical Center.
- Fill out Student Checklist (Print and Return)
- Fill out Statement of Responsibility and Confidentiality - 2 forms (Print & Return)
Other Student Forms (Nursing Students only)
- Glucometer Test (Print & Return)
- Glucometer Policy (Read only)
- Nursing only Checklist (Print & Return)
- Nursing Student CERNER Access Request Form (Print & Return)
- PYXIS ES Tutorial and Exam (Link to Pyxis ES tutorials)
- PYXIS ES website instructions (View & Print)
- Fill out Immunization Verification Form (Print & Return)
- Fill out School Checklist (Print & Return)
- Fill out Student Placement Tracking Form (Print & Return)
- Please e-mail Hope Evans email@example.com and Jennifer Leistiko firstname.lastname@example.org the completed Nursing Student CERNER Access request form for Student Cerner access. Please allow two weeks for processing.
Fill out the school portion of the Background Release Form after the student has filled out their portion of the form unless the student is providing a copy of the background check with the release form. The background must include a national sex offender search and an exclusions list check as well as the national criminal background check
Any documents that need to be filled out (not including the documents that were for review only) will need to be turned into by the student when they receive CMC ID Badge and prior to the start of a rotation. The student must present a state or government issued ID in order to obtain their CMC ID badge.
Maria Phillips, Student Coordinator