University Affiliation Manual 2009 (Revised 5/2009)
The following instructions
and forms will be utilized in processing University
Affiliate students and instructors for their clinical
rotation with Los Angeles County Department of Public
Health (LAC DPH). All of the forms are new and/or
revised. Please discard all previous versions of the
forms. The forms will be updated and revised
according to changes in the LAC DPH policies and
procedures. Download forms when
needed for each quarter or semester.
Important Timelines
Student Orientation Schedule 2024
Thank you for your
interest in Los Angeles County Department of Public
Health (LAC DPH). We look forward to precepting/mentoring
your students. Prior to your students beginning their
clinical rotation with LAC DPH, each student must be
live scanned and cleared; there are no exceptions. To
ensure the process is conducted efficiently and each
student is processed in a timely manner, the following
steps must be completed.
A. The clinical coordinator/student coordinator
completes and submits the following forms to LAC DPH
Nursing Administration no later than ten (10) weeks prior
to first day of clinical rotation via email to
universityaffiliates@ph.lacounty.gov
WOC Request Form
Instructor and Student List This form needs to be
submitted with the WOC request forms
Without Compensation (WOC) Request Form and Instructions
This form is to be completed by instructor or
coordinator for each student and instructor
LAC-DPH Nursing Administration will notify University's
clinical coordinator/designee completing the WOC forms
of students'
eligibility to make live scan appointment.
LAC DPH Nursing Administration
will notify University's
clinical coordinator/designee of
all live scan results. Students who have not cleared
will not be allowed to rotate through LAC DPH, and the
University will have to place the student with a non-LAC
DPH facility.
B.
Requirements for Practice in Clinical
Facilities Form and
Instructions: Faculty and students are required
to provide all necessary documentation related to the
"Requirement for Practice in Clinical Facilities" form.
This includes up-to-date vaccinations, current BCLS,
current car insurance, valid driver's license/ID, as
well as other requirements. This completed form is due
to LAC DPH Nursing Administration 3 weeks prior to the
start of
clinical rotation.
C.
Clinical Rotation Selection Schedule Form: In
order to ensure that each affiliate university receives
the best possible experience, the clinical coordinator
must complete and submit the University Affiliation Clinical Rotation
Selection Schedule. Please download the University Affiliation Clinical Rotation
Selection Schedule and submit the completed form via e-mail
to
universityaffiliates@ph.lacounty.gov. This form
must be submitted by May 15, 2024.
D.
Evaluations: Annual Year End
Evaluation Forms are due to Nursing Administration no
later than July 17, of every year. Please
disregard previous forms located in the University
Affiliates Manual.
