Clinical Nurse Practitioner and Physician Assistant Students

Clinical Nurse Practitioner, Physician Assistant or Nurse Anesthetist, Student Process

There are nine (9) steps listed below. Several steps reference documents that must be returned to your Program Clinical Coordinator at least two weeks prior to your intended rotation start date. Incomplete materials will not be accepted which may result in a delayed start date.

Steps To Be Completed

1. Registration (updated 12/19/2013)

Complete the entire form, ensuring a start and end date and the name of the St. Luke’s Hosting Supervisor are listed. Please print and return the registration form to your Program Clinical Coordinator.

2. FBI Fingerprinting

Please follow the process detailed in the FBI Clearance Handout, in addition to completing the Child Abuse Clearance and PA State Criminal History Check and submit the originals to your school program director.

Universal Child Protective Services Law Affirmation Form (updated 4/25/15)

Please print and return to your Program Clinical Coordinator.

3. Commitment to Privacy

Please print and return to your Program Clinical Coordinator.

Student Statement of Responsibility

Please print and return to your Program Clinical Coordinator.

Student IT Access

Please print and return to your Program Clinical Coordinator.

Student Volunteer Instructor Research Consent and Release Form (updated 3/23/2016)

Please print and return to your Program Clinical Coordinator.

4. Immunization History Form (updated 05/22/2014)

Please ensure your health history meets the requirements outlined in the Immunization History form. Students are responsible for paying for additional immunizations or testing.
It is important to note that all students are to have the most current, annual flu shot during flu season. Exemptions (religious or medical) may be submitted to your school program director and will be reviewed by St. Luke’s personnel for review. Your school program director will be notified if the exemption is approved.
For those with questions regarding new flu requirement, please review this FAQ developed by our Employee Health Department.

Drug Screen Requirements Form

Your Program Clinical Coordinator can provide you with the names of approved facilities to have the drug screening completed.

5. Standards of Performance Booklet

Please read this booklet as it contains the guiding principles of St. Luke’s University Health Network which student interns are expected to uphold.

6. Essentials Newsletter

Please read the newsletter; it explains important safety practices and policies every student must be aware of during your internship at St. Luke’s University Health Network.

7. Orientation - Review the following pages.