Department of Advanced Practice

Program Clinical Coordinator Rotation Process for Clinical Nurse Practitioner, Physician Assistant and Nurse Anesthetist, Students

Education - Advanced Practice

Program Clinical Coordinator Rotation Process for Clinical Nurse Practitioner, Physician Assistant and Nurse Anesthetist, Students

Please read the below information which outlines St. Luke’s requirements to process a Nurse Practitioner, Physician Assistant or Nurse Anesthetist student. The Registration; Commitment to Privacy; IT Access form & Agreement; Student Statement of Responsibility; Coronavirus Screening Form and Research Acknowledgement and Record Verification forms are to be returned to the St. Luke’s University Hospital - Bethlehem Campus at least two (2) weeks prior to the student's intended start date to Those students who have a criminal history are to also include the Criminal Background Investigation Report form and all original State/Federal issued criminal reports.

Rotation start dates will be delayed if materials are not received at least two weeks prior to the student's intended start date.

Please note that audits will be conducted to verify St. Luke’s standards are met. Educational contracts will be revoked if files are incomplete.

Please contact with any questions.

Steps To Be Completed

1. Guidelines for Processing Clinical Nurse Practitioner, Nurse Anesthetist and Physician Assistant Students

Please read the attached for an explanation on processing student interns. 

2. Students with a criminal history report

Criminal Background Investigation Report

  • If a criminal history is reported on the FBI Fingerprint Report, Child Abuse Clearance or PA State Police Criminal Background Check, please print this form and have the student complete and mail, along with all original criminal history reports, to

3.  Health History and Screening requirements: St. Luke's health history requirements should be completed and kept on file at the school.  Students are responsible for costs associated with additional immunizations or testing.

   a. Immunization History Form 

  • It is important to note that all students are to have the most current, annual flu shot during flu season. Only religious or medical exemptions will be considered and should be submitted by completing the appropriate form (religious exemption form; medical exemption form) along with the other required documentation and verification form. School program directors will be notified if the exemption is approved. Exemptions not approved will require the student to either have the flu shot or their internship will not be approved.
  • For those with questions regarding new flu requirement, please review this FAQ developed by our Employee Health Department.

    b. Drug Screen Requirements

  • St. Luke’s requires a five-panel drug screen on all Physician Assistant students as explained in the attachment.
  • If the school does not have a method of providing drug screening, drug screen services are available through St. Luke’s Occumed Resources located at St. Luke’s North. Please contact 610-739-9332 for further information or to set up an account.

     c. TB Questionnaire

  • Please print the attached form and provide to students who have had a positive TB test in the past. This form, along with a clear chest x-ray and/or BAMT (Blood Assay Mycobacterium Tuberculosis) test, should be kept with the student's medical file.

      d. Hepatitis B Declination Form

  • Having the Hepatitis B series is strongly recommended for students completing an internship at St. Luke’s, but is not required. Should a student decline the vaccine, the attached form should be completed and kept on file with their medical history.

4. Records Verification form (forms updated 11/01/2019)

Students assigned to St. Luke's facilities within Pennsylvania:  Record Verification for Student Interns

  • Please print the attachment and return to along with the remaining required forms to be returned, outlined in the attachment in Step 1.

Students assigned to St. Luke's Facilities in New Jersey: Warren Campus Student Verification Form

Students assigned to the Warren Campus will need to complete the New Jersey State Police Criminal History Check.

5. Please return the Registration, Commitment to Privacy, IT Access, Record Verification, Coronavirus Screening Form and Student Statement of Responsibility and Research Acknowledgement forms to:

  • For students assigned to the Warren Campus and other New Jersey sites to:
    Keesha Eato
    St. Luke's Coventry Family Practice
    755 Memorial Parkway, Suite 300
    Phillipsburg, NJ 08865
  • Incomplete materials will not be accepted, which may delay your student's start date.