Welcome to Kaiser Permanente South Bay Medical Center!

If you are interested in requesting inpatient 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.

• Request for Inpatient Student Placement – This form must be filled out by the student or instructor 3 months before anticipated start date. Submit your completed request to: SB-Students@kp.org.

  FALL	SPRING	SUMMER
  For August/September start	For January/February start	For May/June start
  Submit request by: April/May	Submit request by: October/November	Submit request by: February/March

  
  

STEP 1
Nursing Staffing Office
You will find below the REQUIRED form that must be completed and submitted to Deanna Suarez (Deanna.R.Suarez@kp.org) in the Nursing Staffing Office.

• Common Provider Master (CPM) Form – This form must be filled out by the school 1 month before anticipated start date of rotation.

STEP 2
Employee Health Services Clearance
You will find below the REQUIRED forms that must be completed and submitted to Employee Health Services (EmployeeHealth-SouthBay@kp.org) 1 month before anticipated start date of rotation.

• Student Health Screening Requirements Form

• Interval Health Evaluation Questionnaire Form

• Tdap Declination Form
  Note: Tdap Declination is not accepted in Maternal Child Health areas

STEP 3
Nursing Education & Professional Development Department Clearance
You will find below the REQUIRED forms that must be completed and submitted to the Nursing Education & Professional Development Department (SB-Students@kp.org) 3 weeks before anticipated start date of rotation.

• Inpatient School Affiliates Checklist
  This form will guide students and instructors in completing the requirements necessary to start their placement within the medical center.

• 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.

Competency Validations

You will find below the REQUIRED forms that must be completed and submitted in order for instructors/students to gain access to the Pyxis medication dispensary and the Nova StatStrip Glucometer machines.

• Pyxis Access Instructions for Faculty

• Nova StatStrip Access Instructions for Faculty

• Nova StatStrip Competency Record

General Information

• Medical Center Map

• KP SBMC Inpatient Administrator List

• KP SBMC School Affiliate Handbook – This handbook covers all Kaiser Permanente South Bay Medical Center and Nursing Education & Professional Development Department policies and procedures for a rotation/preceptorship.

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

• Conference Room Request – Contact: HarborCity.Resource-Scheduler@nsmtp.kp.org for any inquiries.

Questions?
If you have any questions or concerns, please contact:

Nursing Education & Professional Development Department
Email: SB-Students@kp.org
Telephone: (424) 251-7686

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