1. Student Packet Submission Individual Student Preceptorship
Student Packets include the following COMPLETED forms (In this order):
From main page of website:
Individual Student Orientation Verification (2 pages)
Child Abuse Reporting Requirements
Elder and Dependent Adult Abuse Reporting Requirements
Confidentiality Agreement (3 pages)
Drug-Free Workplace – Employee Acknowledgement (2 pages)
HealthConnect Confidentiality and Non-Disclosure Agreement
Compliance/HIPAA Security Program
KP Learn Completion Certificates
SCAL 2017 New Employee: Safety & Environment of Care Training
Orange County Annual Training and Review 2017
Annual Compliance Training 2017
Safe Patient Handling (Hospital INITIAL ASSIGNMENT CA ONLY) 2017
Nursing Students ONLY: KP HealthConnect Inpatient Training for Nursing Students – SCAL
Copy of:
Immunizations/Titers (See page 2 of this attachment)
BLS Card (Front & Back)
Copy of 10-panel Urine Drug Screening Results (See page 3 of attachment)
Copy of Criminal Background Check Results (See page 3 of attachment)
Copy of Licensure If Applicable (ex: RN License)
ONLY complete packets submitted electronically in the listed order as a single PDF will be processed.

2. Student Packet Submission Individual Student Preceptorship
Vaccination requirements to be included in student packet:
TB Testing
Proof of 2 negative TB tests within the last 24 months:
1 negative must be within the last 12 months
If positive TB test, we require documentation of a negative chest X-ray within 1 year of the start of your current school program
MMR
Positive Titer – OR--2 Vaccination Dates
Vaccination is mandatory if non-immune and no vaccine record.
Declinations are not accepted.
Varicella
Positive Titer – OR--2 Vaccination dates
Hepatitis A (Food Service students ONLY)
Hepatitis A antibody titer –OR--2 Vaccinations, 6 months apart
Hepatitis B
Antibody Titer is REQUIRED by ALL students!
If titer is Negative:
3 Vaccination dates –OR-- Declination form
Declination forms are highly discouraged
Seasonal Flu
Required of ALL students on campus during flu season.
Declinations not accepted for ANY reason.
Tdap
Provide Date of vaccination within last 10 years
Declination form available Declination forms are highly discouraged
ONLY complete packets submitted electronically in the listed order as a single PDF will be processed.

3. Student Packet Submission Individual Student Preceptorship
10 Panel Urine Drug Screening Requirements:
Amphetamines
Barbiturates
Benzodiazepines
Cocaine
THC (Marijuana)
Methadone
Methamphetamines
Opiates
PCP
Tricyclic Antidepressants
Background Check Requirements:
Verification of legal name
Verification of social security number
Verification of address
Seven years of residence/background/criminal history in residing counties
Sex offender database search
Felony and misdemeanor criminal record search
Federal Criminal Records search
Search through applicable professional certification or licensing agency for infractions if student currently holds a professional license or certification (e.g. respiratory therapist, CNA)
ONLY complete packets submitted electronically in the listed order as a single PDF will be processed.