Requirements
Requirements for Students & Instructors
- A Valid Affiliation Agreement
- Signed HIPAA Training Certificate
- Signed UCLA Health Confidentiality Form (see DOCUMENTS section below)
- Background Check (livescan not necessary)
- Physical Examination
- Immunization Record (see the below requirements)
- A Current School ID Badge
- Current BLS card
- COVID-19 Proof of Vaccination (Full dose plus booster) OR Letter of Exemption
- Respiratory Fit Test
- Self-Study Orientation Guide and Staff Information Handbook
- Nursing Department Specific Orientation-Instructors
- Nursing Department Specific Orientation-Students (this can be completed in the first week of your practicum)*
- Life and Safety Checklist-Instructors
- Life and Safety Checklist-Students (this can be completed in the first week of your practicum)*
DOCUMENTS
Below are the documents that are required to be submitted through the Clinical Facilities Form by the School's Student Coordinator:
Expires a year after initial completion. Form must have printed name and signature.
Expires a year after initial completion. Form must have printed name and signature.
Must be completed for each submission to gain proper AD access.
Must be completed to gain access to the Pyxis™ MedStation™.
Required Immunizations
UCLA Health has very specific requirements for immunizations in order to be placed on the units. Instructors and students must provide all documentation to their school and the school must have these available upon request.
It is the school's responsibility to ensure that the instructors and students rotating at UCLA hospitals are tested for and free of active tuberculosis. To meet this requirement, a Quantiferon Gold, T-Spot, or " 2-Step" Tuberculin Skin Test must be completed within 3 months of UCLA student placement assignment. Students with assignments that excess 12 months, must be TB tested annually and be free of active Tuberculosis at all times.
**Waiver for Immunizations are not permitted unless due to medical reasons.
Please see Student Nurse Immunization Checklist (PDF) for the below required immunizations.
COVID-19 Vaccination | Proof of COVID-19 Vaccination (full dose plus booster) OR Letter of Exemption |
| Measles, Mumps, and Rubella (MMR) | Medical documentation of TWO MMR vaccinations OR Medical documentation of ONE BLOOD TITER indicating immunity to MMR Disease history of MEASELS, MUMPS, and RUBELLA will not be accepted |
| Varicella (Chickenpox) | Medical documentation of TWO VARICELLA vaccinations OR Medical documentation of ONE BLOOD TITER indicating immunity to VARICELLA Disease history of CHICKENPOX will not be accepted |
| Tuberculosis (TB) Test | Medical documentation of a QuantiFERON Gold (also known as t-spot) blood in the last 12 months |
| Tetanus, Diphtheria, Pertussis (Tdap) | Medical documentation of Tdap vaccination OR Signed Tdap declination if unable to provide medical documentation. Tdap Declination Form |
Influenza Information | |
| Flu Shot | From November 1st through March 31st, healthcare personnel must either be vaccinated for influenza or wear a mask when in direct contact with patients, providing direct patient service (within six feet), or in a patient room at Ronald Reagan UCLA Medical Center, UCLA Medical Center, Santa Monica, and UCLA Resnick Neuropsychiatric Hospital. Students and/or instructors are not eligible to receive the free flu shot services provided by UCLA Health or redeem the CVS voucher. Flu shots must be received privately by the student and/or instructor. Students/clinical instructors may obtain a flu badge for the season through UCLA Health Occupational Health and present proof of flu vaccine. |
Diana Medina
|