Required Clerkship Documentation

Required Clerkship Documentation

All documents listed must be submitted four (4) weeks prior to the start date of your rotation. If you are applying through VSAS, FHESPAA (Computer Access Form) document must be uploaded to your VSAS profile.

Florida Hospital Documents:
• Approved FH GME Clerkship/ Visiting Resident or Practitioner Application with your signature and that of your preceptor. If you are a medical student applying through one of our residency programs, I will request preceptor approval on your behalf. Please be sure to include exact rotation dates, as these are the dates used for computer and badge access.

• Florida Hospital Electronic Student Physician Computer Access Agreement.
Computer Access Form

Required Documentation:

• Letter of Good Standing on official letterhead

• Certificate of Malpractice/Liability Insurance: Certificate must state full coverage and a minimum amount of $1M occurrence/ $3M aggregate

*Background Security Check: Must be clear and only valid if completed while enrolled in your current program.

*Five panel Drug Screen: Amphetamines, Marijuana, Cocaine, Opiates and Phencyclidine. Must be negative and only valid if completed while enrolled in your current program.

Student Requirements:

• Curriculum Vitae or Resume

• Photo Identification (copy of your driver license or passport is acceptable)

• School/Program Identification Badge: Your Program ID badge must be worn with the Florida Hospital ID badge issued at orientation. Both badges must be worn at all times. You must also be accompanied by your Preceptor at all times.

• *Health Insurance: Proof of personal health insurance (copy of card is acceptable)

• *Immunizations: MMR Vaccination - Varicella Vaccination or Immunity and Hepatitis B (If refused, you must provide a signed waiver.)

• Copy of Negative PPD or Clean Chest X-ray (Annual Requirement within 12 months of your rotation dates) If you return for another rotation you must provided updated PPD or chest x-ray as necessary.

• Copy of Respiratory Mask Fit Certificate (Annual Requirement within 12 months of your rotation dates): Fittings may be scheduled during orientation by the Clerkship Coordinator for a $45 exact cash only fee, with advance notice; however this is not always an available option. Fittings can also be scheduled with CentraCare with prior authorization by the Clerkship Coordinator for a $45 fee. Please contact the Clerkship coordinator in advance to know which option is available at that time.

OUT OF STATE VISITING REISENTS AND FELLOWS: Copy of State of Florida Temporary Training License

ADVANCED PRACTITIONERS: Copy of Nursing License

*The GME office will accept a statement of attestation, in the letter of good standing, for any starred items.