Children's National Medical Center (CNMC)

PEDS Clinical Groups ONLY
 

1. Read both Orientation guides.  (Revised Affiliate Orientation PPT & Special Category Packet)
2. Print and complete the Safety Quiz. Remember your name at the top of both sheets.
3. Print and Sign the HIPAA Privacy and HIPAA Acknowledgement.
4. Print and sign the Orientation Acknowledgment form.
5. Print and sign the Confidentiality form.
6. If going into spring semester, print the “flu vaccine received elsewhere” form and fill out.  Print a copy of this season’s flu vaccine documentation.
7. Please email the clinical coordinator a plain photo of yourself. It can be taken with your phone; just your chest up to your head. Use a plain white or off-white background. 
8. Email all 5 documents to [email protected] by specified due date. (Safety Quiz - 2 pages, Acknowledgement form, Confidentiality form, flu shot received elsewhere form, and flu shot documentation).  And do not forget to email the photo by this date, as well.

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Sr. Practicum Students ONLY
 

1. Fill out the Contact Information form.
2. Fill out the Contingent Worker Form.
3. Read both Orientation guides. (Revised Affiliate Orientation PPT & Special Category Packet)
4. Print and complete the Safety Quiz. Remember your name at the top of both sheets.
5. Print and Sign the HIPAA Privacy and HIPAA Acknowledgement.
6. Print and sign the Orientation Acknowledgment form.
7. Print and sign the Confidentiality form.
8. If going into the spring semester, print the “flu vaccine received elsewhere” form and fill out.  Print a copy of this season’s flu vaccine documentation.
9. Please email the clinical coordinator a plain photo of yourself. It can be taken with your phone; just your chest up to your head. Use a plain white or off-white background. 
10. Email all documents to [email protected] by specified due date.