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1. Complete Alliance Spine Intern/Extern Application
2. Copy of your Advantage Students background check & drug screen
3. Copy of medical insurance card

Submit a copy of all of the above to the credentialing specialists in room 3016 or 3039A or email to nu_medrecords@kennesaw.edu 

1. *IF YOU ARE A MALE STUDENT* We are required to report to the VA the status of your registration for selective service. Please email nu_medrecords@kennesaw.edu and declare whether or not you are registered.
   
   
2. Review and complete the  and documents listed on the checklist.  Signatures cannot be electronic. Documents not fully completed will not be accepted by the VA.
   
   
3. You must have your Driver鈥檚 License, & SSN card on your first day onsite.

Submit all documents including copies of your medical documents to the submission box for NURS 3314 at the Nursing reception desk.

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List of all documents to meet VA requirements:

• Student Cover Page and Checklist (3 completed pages)
• VA Application for Health Professions Trainees (4 pages)
• Declaration for Federal Employment (2 pages)
• Appointment Affidavit (does not need to be notarized)
• Health Professions Trainee Random Drug Testing Notification & Acknowledgement Memo
• Without Compensation Health Professions Trainee Offer Letter
• Students must review the Student Nurse Education Module which includes the following Atlanta VAMC polices and complete a set of test questions:
  • Includes:  Administration of medications; patient lifting, restraints & seclusion & Code 99
• Four Certificates of completion: (4 pages 鈥� use the TMS Help Resources 鈥� Students User for assistance as listed on your student cover page)
  • 1) Mandatory Training for Trainees
  • 2) Safe Patient Handling & Movement Video
  • 3) Preventive Management of Disruptive Behavior- PMDB Level I
  • 4) Mental Health Environment of Care Checklist Training for Clinical Staff
• Varicella Guidelines and Waiver or Proof of vaccines or positive titer
• HepB Vaccine Waiver Statement or Proof of positive titer
• Covid-19 Vaccination Form & proof of vaccines
• Negative PPD, QuantiFERON Gold, Tspot or Chest X-ray within 12 months which may not expire during your clinical rotation
• Flu vaccine (optional)
• Front and back copy of your CPR card

• Student Information - No paperwork.

Since the Cartersville Medical Center is now part of the Piedmont System, see  below and follow the instructions.

1. Complete Internship Volunteer Paperwork

2. Please provide the additional documents:

   Copy of background check
   Copy of state ID
   Copy of school ID

3. After completion of above documents please submit to Room 3014 or e-mail to nu_medrecords@kennesaw.edu

When assigned to this location, please email nu_medrecords@kennesaw.edu for a documentation link to complete the required online forms.

In the event you have an issue with one of the requirements please contact Lisa Longeiret at nu_medrecords@kennesaw.edu for resolution.

• All forms to be completed on-site the first day of clinical (please take driver's license)
• Bring a copy of your Advantage Students background check and drug screen with you to Orientation
• Orientation must be completed prior to clinical rotation start date. Your instructor will contact you with further instructions.

• Click on assigned camp website and complete Volunteer Application
• If Letters of Recommendations are required, submit recommendations sealed in separate envelopes with your Camp Application
• Submit completed applications and letters of recommendations (if applicable) at room 3006 NO FAXES

Camp Braveheart

Children's Healthcare of Atlanta
1405 Clifton Road, NE
Atlanta, GA 30322-1062
Phone: 404-785-6735
Toll Free: 800-542-2233

For kids with heart defects and heart transplant recipients.

Camp Breathe Easy

American Lung Association in Georgia
2452 Spring Road
Smyrna, GA 30080
Phone: 404-231-9887 x223

For kids with asthma.

Camp High Five

H.E.R.O. For Children
4497 South Old Peachtree Road
Norcross, GA 30071
Phone: 404-616-9809

For kids who are affected by HIV.

Camp Independence

National Kidney Foundation serving Georgia
2951 Flowers Road South, Suite 211
Atlanta, GA 30341
Phone: 770-452-1539, ext. 20
Toll Free: 800-633-2339

For kids with kidney disorders and transplants.

Camp Krazy Legs

Kids with spina bifida

Camp Kudzu

577 Concord Rd. SE 鈥� Suite B
Smyrna, GA 30082-2609
Phone: 404-250-1811


For kids living with type I diabetes.
Submit the application online

Camp New Hope

Sickle Cell Foundation of Georgia
2391 Benjamin E. Mays Drive
Atlanta, GA 30311
Phone: 404-755-1641


For kids with sickle cell disease.

Camp No Limb-itations

Kids with limb defects

Camp Strong4Life

Focus on health and weight

Camp Twin Lakes

Focus on illnesses, disabilities, and other life challenges

Bring a copy of the following to room 3016 or 3039A

Copy of your Advantage Students  background check and drug screen
Copy of your most recent TB test result 

• No special requirements

Emory uses ACEMAPP as their credentialing tool. Please review requirements for Emory facilities in ACEMAPP.

For help with the ACEMAPP, please contact their support team below:
Email: support@acemapp.org
Phone: 844-223-4292

Emory University Hospital Midtown: Badge office hours are M-F 7-3:30 (closed for lunch from 12:30-1:00), located on the F level of the Glenn Building (adjacent to the visitor parking deck). Students are required to find parking in other pay lots. There is a lot at the corner of Peachtree and Pine for $5 per day if in by 9:00 a.m.

St. Joseph鈥檚 Hospital: Your KSU student badge is the only badge required at this location. See ACEMAPP for parking information.

Floyd Medical Center uses ACEMAPP as their credentialing tool. Review requirements for Floyd Medical Center in ACEMAPP.

For help with the ACEMAPP, please contact their support team below:
Email: support@acemapp.org
Phone: 844-223-4292

Fulton County School Notification of No Workers Comp Form MUST BE NOTARIZED and submitted to Room 3016 or 3039A, Prillaman Health Sciences.

• Form must be signed and dated in front of a Notary
• You must also provide picture ID

Notaries in Wellstar School of Nursing:
Stacy Lynn Richardson srich129@kennesaw.edu
Lillian Valdez lvaldez2@kennesaw.edu

 

 

CONFIDENTIALITY FORM  

Student nurses need

• To review and complete the Attached Confidentiality Form, bring with them the first day of assignment
• To contact the precepting nurse for the exact times to plan on working in that particular school clinic
• To ask of the best place to park at the assigned school
• To know that cell phones are to only be used in extreme emergencies at the permission of the Mentoring Nurse
• To dress in their school uniform, Hair to be professional and no perfumes.
• To bring a lunch or plan to buy lunch at school (approx. $4.00).
  *Should not leave the school for the 20-30 minute lunch break
• To come prepared with goals of what they want to learn and accomplish.
• To know that they will not only observe but will be an active part of the school clinic.
• To please email or phone the mentoring nurse if the student nurse will be late or not able to attend clinicals.

• Fulton County School Notification of No Workers Comp Form
  MUST BE NOTARIZED and submitted to Room 3014, Prillaman Health Sciences
  • Form must be signed and dated in front of a Notary
  • You must also provide picture ID
  • Notaries in Wellstar School of Nursing:
    • Stacy Lynn Richardson srich129@kennesaw.edu
    • Lillian Valdez lvaldez2@kennesaw.edu

1. Download and Review the Orientation documents: Orientation Packet 1 and Orientation Packet 2.
2. Download and Review the Gordon Hospital Policy Pack.
3. Download and Complete the Student Packet.
4. Scan and e-mail documents to nu_medrecords@kennesaw.edu (or bring to room 3014)

Medical Documents (must be submitted with your clinical paperwork)

Immunizations

1. Proof of TB Testing
2. Proof of TDAP immunization
3. Proof of Varicella or titer value report
4. Proof of two MMR immunization or titer value report
5. Proof of three Hepatitis B immunization or titer value report
6. Flu Vaccine:
• Fall semester: flu documentation must be submitted by 2nd Friday in October
• Spring semester: flu documentation must be submitted with clinical paperwork.

You can submit page one of your physical, attach additional immunization documents to ensure all above medical requirements are met.

Grady Health System uses ACEMAPP as their credentialing tool. Review requirements for Grady facilities in ACEMAPP

For help with the ACEMAPP, please contact their support team below:
Email: support@acemapp.org
Phone: 844-223-4292

UNIVERSAL MASK POLICY
Grady requires that all persons wear a mask while at the hospital or any of our other locations. For staff (and students), that means a mask must be worn in areas including, but not limited to, hallways, atriums, elevators, patient care areas, the cafeteria and any location where staff cannot safely socially distance. The mask may be an N95 mask, a surgical mask, or a cloth mask that covers the nose and mouth. The mask requirement also applies to patients and visitors. We must all work together to ensure this policy is followed. 

Students register for Grady Orientation through ACEMAPP on the events tab.* Directions/information regarding this process (and GO in general) is located on the Student & Faculty announcement tab

1. Complete orientation materials in ACEMAPP
2. Log into your Advantage account by clicking the Vendors tab in ACEMAPP. Select Grady Health System to share your reviewed results
3. All students will be required to pay $1.00 badge fee to Grady Hospital before receiving their badge. Community and Practicum Students, badges must be picked up no sooner than 3 days prior to the beginning date of your clinical rotation, you will be unable to begin your rotation without your badge.
4. Parking - Students will be required to pay a $10 deposit for a hang tag to be displayed in their vehicle while parked at the designated lot.  The deposit will be reimbursed upon turning in the tag

Maternal Health 3318 Students ONLY:

• Students will be required to obtain an additional fingerprinting package from Advantage Students. Please follow the directions and your instructor will inform you when you have been cleared. Do not delay, this takes additional time and you will not be able to start your rotation until it has been completed through Advantage. 
• Choose the selection 鈥淕rady Hospital - Intern Fingerprinting鈥� as your school / program, after downloading the advantage student document with the directions.

• Visit the  and register

• Parking and Badge

• Students must return their badge at the end of the rotation.

• Badge office hours are now 7am to 4pm.

• No special requirements

• Kaiser Permanente will contact you 2-3 weeks before your clinical rotation begins.

Since the KSU Health Clinic is now part of the WellStar Health System, see WellStar Health System (Kennestone, Cobb, Windy Hill, Paulding, Douglas and First Steps) below and follow the instructions.

• Please contact MedSide Healthcare Corporation -  Home Health Administrator Beatrice Coulombe to register for your Orientation.  Orientation must be completed prior to the start date of your clinical rotation.  Orientation is conducted every Monday from 9:30am to 3:30pm. 
• Complete the attached paperwork fully and bring everything to your scheduled Orientation.

Document Checklist

• Authorization to Request Records (2 separate forms, 1 page each)
• Consent to Photograph (1 page)
• Post 鈥� Offer Health Screen (3 Pages)
• Chamblee Police Department Criminal History Consent Form (1 page)
• Confidentiality Agreement (4 pages)

No paperwork

• Immunizations needed for clinical at NSH
  • 飩� TB - Negative QuantiFERON Gold or T-Spot required, Negative PPD will NOT be accepted.
    
    • I recommend the Health Department to obtain a current negative TB blood test if you do not currently have one on file.
    • Download and view the flow chart (pdf) for your particular situation.
  • Proof of tetanus immunization
  • Proof of two Varicella or titer value report
  • Proof of two MMR immunization or titer value report
  • Proof of three Hepatitis B immunization or titer value report

• Students who are also Northside Employees: please follow steps as indicated in ACEMAPP to verify your employee affiliation BEFORE uploading your health documentation.
• 4417 senior practicum students do not report to your unit before picking up your badge; instructions to do so will be given to you by your clinical instructor.

Parking and Badges

• NSH-ATL: all students and faculty are to park at the Orange Parking Deck
• NSH-CHER: senior practicum students ONLY, please pick up badges from Toni McPherson once you receive clearance for all requirements in ACEMAPP. Call (678-388-6404, 7:30 to 4:00) to make an appointment for badge pickup.

Piedmont Healthcare is now using ACEMAPP as their credentialing tool. The required documents will be in ACEMAPP and the deadlines for completion will be listed on the ACEMAPP site. Make sure that your KSU email address is in ACEMAPP.

Please review this  for information about Piedmont鈥檚 requirements in ACEMAPP.

*Please note: Piedmont requires an annual background check. If your most recent background in Advantage Students is more than 12 months old at the time you are assigned to a Piedmont rotation, you will need to purchase a new background check. Do not purchase an additional background check until you are assigned to this location by the Student Placement Coordinator.

Parking Information

Piedmont Henry is now a pay-to-park facility with designated parking for staff and students.   
Effective June 1st, the parking lots will be gated, and lots are designated as staff and visitor parking. Visitor parking rates are as follows:

Up to 20 minutes = Free
21 mins. 鈥� 2 hours = $2
2 hrs.  鈥� 5 hours = $4
More than 5 hours = $5 per day

For students, Piedmont offers parking permits. This permit is valid only for the Orange Lot, which is adjacent to the Education Building. Permits can be obtained through the Parking Office once credentialing is complete in ACEMAPP. The Parking representative will be available Tuesdays and Thursdays from 0900-1200 in the Lobby of the Education Building. The fee is $10 and covers the entire rotation. Lost or stolen permits will incur a $25 replacement fee. Once the rotation is complete, the expectation is for permits to be returned to the Parking Office. 

1. Go to 
2. Read and follow the instructions to access your credentialing documents
3. Badge Pickup: Badges must be picked up from HR (open 8鈥�4) before rotation begins

Medical Documents
(must be submitted in ACEMAPP and up to date by the designated clinical documentation deadline)

1. Front and back copy of your current CPR card
2. Immunizations
   • Proof of TB Testing
   • Proof of two Varicella or titer value report
   • Proof of two MMR immunization or titer value report
   • Proof of three Hepatitis B immunization or titer value report
   • Proof of Tdap
   • Current Flu documentation (Oct 1st to March 31st)

Clinical Requirement Checklist

Students need the following requirements met:

• Negative Back Ground Check 鈥� share with Redmond
• Negative Drug Screen- share with Redmond
• Hand Hygiene Compliance Form (send to Stacy Lynn Richardson  srich129@kennesaw.edu)
• (Oct 1st to March 31st)
  
  

Passing score of all 3 items listed below:

• TCPS FERPA Release & Confidentiality Agreement AY2021-2022
• Nursing, MD & PA General orientation Quiz AY2021-2022
• HealthCare General Orientation Quiz AY2021-2022
• Redmond Regional Medical Center Attestation AY2021-2022

Follow the steps below after you receive your placement from Lillian Valdez

1. You will be receiving an e-mail from Glenn Prescott informing you of the clinical requirements and vetting process for the Shepard Center.
2. Please ensure that you reply to his e-mail immediately and copy nu_medrecords@kennesaw.edu
3. The directions above are for 1st and 2nd group rotations.

You will not be allowed to start clinical until you are cleared by Employee Health at Shepherd鈥檚.

Minimum requirements include:

• National Criminal and sex offender search (7 years)
• OIG/GSA + OFAC 鈥� a combined search of the Office of Inspector General and the general Service Administration is searched for any individuals that has committed any type of fraud against Medicare, Medicaid or other Federally funded healthcare program. Plus, a search of the Office of Foreign Assets Control.

Health Screening: schools must be performing at least one drug screen, checking immunizations, and providing Hepatitis B vaccine/education. Minimum requirements include:

• Negative drug screen testing result
• Two MMR vaccines or titers for Measles, Mumps and Rubella
• Two Varivax Vaccines or history of the chicken pox
• TB test within the last 90 days before placement
• Current flu shot if placed during active flu period as determined by the CDC
• Hepatitis B vaccine and/or education provided

WellStar uses ACEMAPP as their credentialing tool. Review requirements for Wellstar facilities in ACEMAPP

For help with the ACEMAPP, please contact their support team below:
Email: support@acemapp.org
Phone: 844-223-4292

Students must bring a copy of their proof of flu vaccination to WellStar Security for badge pickup. 

• WellStar Kennestone Security
  770-793-7780
• WellStar Cobb Security
  770-732-3990
• WellStar Douglas Security
  770-920-6261
• WellStar Paulding Security
  770-505-7168
• WellStar Windy Hill Security
  770-644-1155

Parking Information for the various hospitals can be found in ACEMAPP.

*Practicum Students ONLY鈥攄o not pick up your badge until 3鈥�5 days prior to your rotation start date

STUDENT BADGE AND PARKING REFERENCE

Thank you and we look forward to your clinical time at Wellstar!