Welcome to Kaiser Permanente South Bay Medical Center!

If you are interested in requesting ambulatory student placement/rotation at Kaiser Permanente South Bay Medical Center, please download and submit the forms below. Submission of any incomplete forms will not be accepted and you will be ineligible for placement. It is highly recommended to submit documents as early as possible to ensure your on-boarding process and/or start date is not delayed. The specified guidelines in the grid will assist you in determining when you should submit your request and is based on the semester of the student placement.

STEP 1
Complete the Request for Ambulatory Student Placement - 3 months prior to the start date of your student placement.

• Submit your completed request form to: SB-Students@kp.org.

STEP 2
Employee Health Services Clearance Documents

• Submit after notification of student placement has been confirmed by the Nursing Education & Professional Development Department.

• Download the three (3) required forms and email it to Employee Health Services: EmployeeHealth-SouthBay@kp.org and cc: SB-Students@kp.org

  • Student Health Screen Requirements Form

  • Interval Health Evaluation Questionnaire Form

  • Tdap Declination Form
    Note: Tdap Declination is not accepted in Maternal Child Health areas (Obstetrics, Gynecology, and Pediatrics)

STEP 3
After notification of health clearance, contact the Nursing Education & Professional Development Department at SB-Students@kp.org  (ATTN: David Largo) and submit:

• Common Provider Master (CPM) Access Form
  To obtain the National User Identification (NUID) (clinical and non-clinical students) – Which is needed to access KP HealthConnect and to complete mandatory Kaiser Permanente online modules through KP Learn

• If you are already a current KP Employee or a former student at KP, please notify David Largo as this will shorten the length of time to obtain access for our medical center.

STEP 4
Download and complete the forms below after notification of health clearance and submission of CPM and/or NUID access.

• Ambulatory School Affiliates Checklist

• Required Documents (zip folder)

• MCW 1128 – Medical Center Dress Code Policy
  Read and review the document. Sign the last page and submit with student packet.

General Information

• Medical Center Map

• KP SBMC School Affiliate Handbook
  Download the Kaiser Permanente South Bay Medical Center School Affiliates Student Placement Handbook to learn more about our policies and procedures for student placement.

• Badge Access Form
  Once cleared by the Nursing Education & Professional Development Department, complete the form and have the Department Administrator of your clinical area sign off the form. Bring the completed form to security for access.

Questions?
Please contact:

Nursing Education & Professional Development Department
SB-Students@kp.org
T: (424)251-7690

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