A current affiliation agreement needs to be in place between KRH and the employee's employer to move forward with educational placements for training rotations. Please contact us as soon as possible to ensure an agreement is current and in place well in advance of an educational experience. This cannot be done by the individual departments and must be approved by the Student Affiliations department.
Paperwork, Documentation and Requirement Information for Educational Training Experiences
1a. Review Acknowledgement of Resources, Confidentiality Acknowledgement and Disclaimer for Intellectual Property
1b. Review EDU800 Policy
1c. Review the Western MT Student Orientation/Requirement Manual
2. Fill out the Personal Information Form below. This will need to be filled out prior to the beginning of any and every rotation and/or experience. This form will be sent directly to the Kalispell Regional Healthcare Student Coordinator when you hit the submit button.
Hands On Trainee Personal Information Form for Clearance at KRH
Background Check Information
1. Submit a copy of a background check along with the Background Check/Release Form
or just a copy of the Background Check/Release Form
filled out by the health care facility with the date the background check was cleared and signed by both the trainee and the training site representative. If you choose the latter, there is a chance we will request a copy of the original background check for auditing purposes.
2. Please check the Office of Inspector General (OIG) http://exclusions.oig.hhs.gov/
and the national sexual offender registry search http://www.nsopw.gov/en-us
and send copies of the clear status for each trainee.
Immunization and Communicable Disease Record Documentation Required
MMR (measles, mumps, rubella)
2 official records receiving shots
Positive results from a titer for each (measles, mumps, rubella) showing immunity.
Record of two vaccinations
Positive titer results showing immunity
If the trainee has recollection of having the disease. They will need to provide documentation in writing from a physician's office.
A titer with reactive or positive results
Can be declined but trainee must sign a Hepatitis B Vaccine Declination
Tetanus w/ Pertussis (Tdap) ***One record required in the last 10 years***
Required **Please note: this must be the Tdap (tetanus w/ pertusis) not td (tetanus diphtheria) vaccination.
Record of Flu shot *****Yearly vaccination is required.******
If trainee will not be doing clinical during flu season, this shot will not be required
Keep in mind if shot is not required at the beginning of the rotation, but the rotation carries over into the next flu season, the student will be required to obtain the shot.
Record two negative TB skin test in the last 12 months (If the test is positive, a chest x-ray required.)
Negative Quantiferon TB blood test.
Parking at KRH
Our parking space is limited so we ask that you park in the Student Parking during day shifts and in the Employee Parking area for night shifts. Please help us save parking for our patients and their families.
Student Parking Map
Any documents that need to be filled out (not including the documents that were for review only) will need to be returned to the KRH Student Coordinator at least 30-60 days prior to the start of a rotation. Feel free to scan and email the documents or if you prefer you can fax them to the secure fax line in the Student Coordinator's office. The contact information is below.
After all your requirements have been turned in and approved by the Student Coordinator, set up an appointment, in advance to be issued your Trainee ID badge.