Students must provide the following documentation to participate in a Preceptorship at Peninsula Regional Medical Center:

  • 2 page PRMC Preceptorship Agreement signed by the student, a school representative and the preceptor. If the preceptor is an Advanced Practice Provider (i.e. Physician Assistant, Nurse Practitioner, Nurse Anesthetist or Nurse Mid-wife), please request your preceptor to have their supervising physician sign the agreement also.
  • Letter of Good Standing from the program
  • Medical Clearance:
    • MMR — two vaccines or positive titer
    • Varicella — two vaccines or positive titer.  History of disease is not acceptable
    • TDAP within the past 10 years
    • Influenza vaccination during flu season (October – April)
  • Copy of criminal background check (including county/state criminal search; can be upon entry to program)
  • Copy of 10 Panel Drug Screen within the past 12 months
  • CPR Card — Basic Life Support
  • Copy of Student ID
  • Copy of Driver’s License
  • Copy of student’s nursing license (or nursing license number and state) when completing a clinical rotation related to an advanced nursing program.
  • Surgical Preceptorships:  documentation of completion of PRMC Surgical Services Orientation is required if precepting with a physician with surgical privileges.  Contact Susan Lynch  susan.lynch@peninsula.org to set up an orientation class.  Students may start their surgical rotations on time, however, will not be permitted in the Surgical Services area (OR) until the orientation is complete.  It can be scheduled on a day during the student’s first week so they do not have to make a separate trip.
  • Complete the highlighted areas of the Information Technology Acceptable Use Policy Acknowledgement and Consent Form along with the checked areas of the Request for Information Services System Sign-On Form (only when the preceptor is requesting IT access.)  DO NOT return these forms to the IT Dept.; please include these forms in your submission  of documents to the Medical Education Coordinator a minimum of two weeks prior to the rotation start date to allow ample time to create your student account.

 

Information Technology Acceptable Use Policy

Information Technology Acceptable Use Policy Acknowledgement and Consent Form

Request Information Services System Sign-On Form