Outpatient Checklist for General Student Placement
Upon approval complete – Outpatient Student Application
Kaiser requires that you have a valid Social Security Number. Otherwise, you must choose another site.
Incomplete packets will not be considered. Please make sure to return all required paperwork in PDF Format only as indicated below along with all supporting documents (immunization health records).
All documents must be legible to read and filled out using Black or Blue Ink only.
- Student Placement Request & Information Sheet
- Affiliated School Checklist for Students
- Immunization records must be attached per checklist above
- Influenza Vaccine Form
- Hepatitis B Vaccine Consent/Declination Form
- Tetanus, Diphtheria & Pertussis (Tdap) Declination Form
- TB Symptom Questionnaire (not required unless submitting chest x-ray results)
- American Heart Association BLS CPR Certificate (and) Professional License
- Background Check and Drug Screen Clearance (actual report)
KP Learn Online Training Modules (must include all completed KP Learn Certificates)
MANUAL TESTS (provided by Nursing Professional Development)
- Fall Prevention
- Patient Restraints
- Blood Product Administration
- Sexual Harassment Brochure – The Facts
Should you have any questions, please contact the Outpatient Student Placement Coordinator:
Clinical Education Practice & Informatics
Office hours: 7:00 am – 3:30 pm
Office: (510) 675-5739 or (510) 675-6844 / Fax: (510) 675-6673