Student Services Credentialing Packet Information

Students that are assigned to a preceptor associated with Clark Regional Medical Center are to complete the Clark Regional Medical Center packet. Required documentation to be turned in 2 weeks prior to rotation start date:

• Immunization records
• TB Skin-test
• Copy of driver’s license
• Drug-screen
• Completed background check (less than one year old)
• Flu Vaccine (October-March)
• Updated COVID vaccine series card
• Verficiation letter for PPE training for donning and doffing
• Completed Code of Conduct (PDF)
• Review student orientation (PDF)
• Complete Student Orientation Signature Sheet (PDF)
• Complete Security Access Request Form (PDF)
• Complete Request to Resume Educational Rotation form (JPG)

Credentialing contact for Clark Regional Medical Center: Tracy Copher

Students that are assigned to a preceptor associated with Fleming County Hospital are to complete the Fleming County Hospital packet. Required documentation to be turned in two weeks prior to rotation start date:

• Letter of good standing from current institution
• Copy of liability insurance
• Immunization records
• TB Skin-test
• Copy of driver’s license
• Completed background check (less than one year old)
• Updated COVID vaccine series card
• Completed Fleming County Hospital Student Packet (PDF)

Download the Fleming County Hospital Confidentiality Statement (PDF).
Download the Graduate Medical Education Policy (PDF).

Credentialing Contact for Fleming County: Kyle Carter

Students that are assigned to a preceptor associated with King's Daughters Medical Center are to complete the following orientation materials. Required documentation to be turned in two weeks prior to rotation start date:

• Signed Exhibits A, B, and C from the Student Handbook (PDF)
• Completed student post-test (PDF)
• Review General Compliance Module (PDF) and return completed and signed Attestation Form (PDF)
• Review COVID Education (PDF) and return completed and signed COVID Attestation Form (PDF)
• Complete TB Risk Assessment Form (PDF) (Student may complete)
• Immunization Requirements per OCC Med:
  • A. Proof of 2 step TB Skin Test or proof of three consecutive years or proof of Blood Assay Mycobacterium
  • B. Proof of Influenza vaccination during Flu Season or copy of Declination Form
• Updated COVID vaccine series card
• Please send a student picture electronically (must be on a KY blue background and no PDF's) to forward to HR to make a student ID badge. If you do cannot send a picture, you will need to make an appointment with HR to have the badge made prior to starting your rotation.

Students that are assigned to a preceptor associated with KDMC are to contact Matt Greathouse for credentialing questions or information.

Students that are assigned to a preceptor associated with the Meadowview Regional are to complete the Meadowview Regional Student Packet. Required documentation to be turned in 2 weeks prior to rotation start date:

• Letter of good standing from current institution
• Copy of liability insurance
• Immunization records
• TB Skin-test
• Copy of driver’s license
• Completed Confidentiality and Security Statement
• Completed Common Ground Code of Conduct
• Completed HIPAA-Patient Privacy Program
• Completed Student SAF Information
• Background Check
• Drug Screen
• Updated COVID vaccine series card

Credentialing Contact for Meadowview Regional Medical Center: Jessica Darnell 

Students that are assigned to a preceptor associated with ARH Hospital are to contact Amber Cole, Administrative Assistant or Stephanie Owens, Regional HR Officer. Required documentation to be turned in 2 weeks prior to rotation start date:

• Letter of good standing from current institution
• Copy of liability insurance
• Immunization records
• TB Skin-test
• Copy of driver’s license
• Completed background check (less than one year old)
• AHEC Student/Resident Fact Sheet

Students that are assigned to a preceptor associated with St. Claire Regional Medical Hospital are to complete the St. Claire packet below. Required documentation to be turned in 2 weeks prior to rotation start date:

Letter from institution stating:

• Student/Resident is in good standing
• Criminal/Caregiver background check completed and does not have any past history of drug abuse, felony, etc
• Drug screen completed and is negative
• Immunization and health records (2 MMR's) are compliant with CDC recommendations
• TB skin tests are compliant with CDC recommendations (1-3 weeks apart within the last year or three consecutive yearly tests or a negative Quantiferon Gold Blood test). 
• Provide copy of current vaccine for the current flu season of October - March. 
• Provide updated COVID vaccine series card. 

Orientation Overview (PDF) must be reviewed prior to your arrival.

Complete one of the following

• St. Claire Regional Credentialing Packet for Students
• St. Claire Regional Credentialing Packet for Residents
• St. Claire Regional Credentialing Packet for Nursing Students
• St. Claire Regional Credentialing Update Packet for Nursing
• St. Claire Regional Credentialing Packet for Nursing Instructors 

* If the institution does not have or keep the requested information on file, the student/resident must submit the following:

• A letter from the institution stating that the student/resident is in good standing
• Criminal/Caregiver background check
• Drug screen completed and is negative
• Immunization records showing proof of 2 MMRs or proof of titers drawn
• Two-step TB Skin Test (two separate tests)
• Flu Vaccine (October-March)
• Must provide updated COVID-19 vaccine series card 

*If you are completing a psychology rotation, please read the following orientation PDF and sign the clinical agreement document:

• Orientation (PDF)
• Clinical Agreement (PDF)

Credentialing contact for St. Claire Regional Medical Center is Jessica Pennington and Sue Russell
Credentialing contact for letter of good standing for St. Claire Regional Medical Center is Jessica Pennington, Student Services Coordinator.

Students that are assigned to a preceptor associated with St. Joseph Mt. Sterling Hospital are to complete the St. Joseph’s Student Packet. Required documentation to be turned in 2 weeks prior to rotation start date:

• Letter of good standing from current institution
• Copy of liability insurance
• Immunization records
• TB Skin-test
• Copy of driver’s license
• Completed St. Joseph’s Student Packet (PDF)
• Completed Statement of Preceptor Responsibility (PDF)
• Completed Statement of Agreement: Student and Preceptor (PDF)
• Updated COVID vaccine series card

Download St. Joseph's Confidentiality and Acceptable Use Agreement (PDF).
Download Ethics at Work Reference Guide (PDF).

Credentialing Contact for St. Joseph’s Hospital: Maddison Mitchum

Students that are assigned to a preceptor associated with Sterling Health Care are also to complete the St. Joseph’s Student Packet. Required documentation to be turned in 2 weeks prior to rotation start date.

• Immunization records
• TB Skin-test
• Copy of driver’s license
• Drug-screen
• Completed background check (less than one year old)
• Flu Vaccine (October-March)
• Bloodborne Pathogens Fact Sheet 
• HIPAA Fact sheet 
• Student Policy 
• Updated COVID vaccine series card

Credentialing contact for Sterling Health: Jennifer Carpenter