Clinical Reqs + Eval

Clinical Evaluation

2013-2014 AY Clinical Evaluation Pilot

SMC Partners Piloting: Linfield, Portland Community College, Concordia University, OHSU, Washington State University, Clark Community College, PeaceHealth SWMC, Providence Portland Medical Center, University of Portland (Spring 2014), George Fox University, Walla Walla University

Student and Faculty Passport Forms

Please click on the following links to access SMC Passport forms:
Student Passport Form
Faculty Passport Form

SMC Minimum Vaccination Requirements

Students and Faculty now have access to a more comprehensive list of SMC vaccination requirements in the Minimum Vaccination Requirements document. This document outlines the minimum vaccinations/screenings required for students seeking clinical placements within the SMC Consortium. For site-specific clinical requirements, please see below.

Clinical Site-Specific Requirements

When assigned to a clinical placement, please access and complete the clinical site-specific requirements and orientation materials for the applicable clinical facility prior to the start of the clinical experience. Students should submit clinical site-specific requirements and orientation materials to your clinical faculty or per the advised instructions. If students have questions, please contact your clinical faculty. Faculty should submit clinical site-specific requirements and orientation materials of your clinical group to the clinical site contact per the advised instructions. If faculty have questions, please contact your clinical coordinator. Coordinators, please provide any updates to clinical site-specific requirements and orientation materials to

Adventist Medical Center (AMC)

  1. Coordinators: Download and complete the Placement Request Form electronically. Once completed, please email the form per the instructions.
  2. Students / Faculty: Complete the Adventist B.L.U.E Book Test and Confidentiality Agreement
  3. Students / Faculty: Complete the Instructions and the Nova Glucose Monitoring Instruction Video
  4. Students / Faculty: Review the AMC Parking Information

Kaiser Permanente Sunnyside Medical Center (KSMC)

  1. Coordinators: Submit the Student Access Request Form at least 3 weeks prior to start date and include faculty if you wish for them to have Epic access 
  2. Faculty: Complete the 2013-2014 Checklist and include with all documents when submitting the clinical site-specific requirements
  3. Students / Faculty: Review the 2013 Student Orientation and complete the Orientation Exam
  4. Students / Faculty: Review the KSMC Parking Map
  5. Students / Faculty: Complete the Confidentiality Agreement and KPNW Behavior Standards
  6. Students / Faculty: Review HIPAA Quick Reference and Nova Stat Strip Glucose POCT
  7. Students / Faculty: Complete the Glucometer Training and print the completion certificate at the end of the video
  8. Students / Faculty: Pick up a HealthConnect (Epic) Training CD from your coordinator or designated SON contact and complete the HealthConnect Exam
  9. Students / Faculty on Dedicated Education Units (DEU): Complete a DEU Student Profile on a Word document with the following information: 1) Personal photo with head and shoulders only;  2) Background information: About, Interests; 3) Why did you choose nursing? and 4) What are your personal and professional goals?


Please review information and supporting documents posted on Legacy Health's Student Nursing Clinical Placement webpage. All students and faculty must complete these education modules annually prior to clinical placements at Legacy Health sites. 
  1. Students / Faculty: Sign the LHS Nondisclosure Agreementfaculty return to Deb Henry, via email or mail D. Henry, Clinical Practice Support, Emanuel, Office #3080.
  2. Students / Faculty: Review and complete the HIPAA Privacy & Security questions on pages 14-15. School to retain these records.
  3. Students / Faculty: Annual Influenza Vaccination or signed Declination Form
  4. Students / Faculty: Complete the Stat Strip Glucometer Competency; competency must be completed prior to start of clinical, preferably during clinical orientation; faculty arrange for glucometer competency with a Super User on the unit; faculty member trains students; complete the self-learning module and print out the certificate and the Competency Checklist; submit the certificate and checklist to the Unit Super User.
  5. Students / Faculty: Complete EPIC Training, which must be completed two weeks prior to start of clinical placement; contact your coordinator or designated SON contact for the login ID and password. Review the Strong Password Policy.
  6. Please note: There is a bug in the Pyxis software involving passwords. The first step with Pyxis access is to use the one-time-use password “PASSWORD” to create your personal password. The software will allow you to type more than 8 characters, but only accept the first 8 characters. When you go to the next step of Pyxis setup (creating the fingerprint Bio-ID), the software won’t accept your new password if you type in more than 8 characters.
  7. Students/Faculty: Complete the ID Badge Request Form; take to any Legacy Security office to receive badge. All schools except Linfield are required to have an ID Badge.
  8. Students/Faculty: Read Legacy Parking Policy
  9. Students/Faculty: Read Legacy Care Communication Policy
  10. Faculty: Please fill out the Student Access Spreadsheet and send to both Deb Henry and Legacy Security. Email addresses for both are included in the document.

Oregon Health & Science University (OHSU Hospitals, DCH)

12/12/2013 Announcement: We have begun mandatory masking up on the patient care units as we have had confirmed cases of the flu and if you have students who have been vaccinated and have proof they can bring to us, we can provide a sticker for their badge so that they do not need to mask up. Any questions, please let Mary Stock know.

9/19/2013 Announcement: To obtain an ID Badge, please go to Room 3255, on the 3rd Floor of Sam Jackson Hall (directly across the street from the main hospital; see a Map) to complete a Student ID Badge Request Form; either Melanie Blehm or Mary Stock can assist you with the form. If you have questions, please visit FAQs or Contact Us. Other helpful links are below:

PeaceHealth Southwest Medical Center (SWMC)

Other helpful links are below:

Portland VA Medical Center (PVAMC)

Important: All completed student application packets must be received by the PVAMC Education Department's OAA Technician a minimum of 6 weeks prior to clinical start date.

All PVAMC clinical site-specific requirements are to be sent to the below address:

OAA Student Processing
Education Division (P6EDUC)
PVA Medical Center
PO Box 1034
Portland, OR 97207

Providence Health & Services / Oregon Region


Coordinators: Providence - Oregon Region will send instructions to complete PRECEPT clinical requests via email and COHORT clinical requests will be considered through ACE-Oregon; contact the specific Providence clinical coordinators or Alex Asbury, Regional Coordinator at SMC, if you have questions. 

Students / Faculty: An Orientation Letter will be emailed to you directly advising you to complete the Student Forms Packet. Submit the packet directly to Providence as indicated in the packet and provide a copy of the email clearance statement to your coordinator or designated SON contact. 
  • HealthStream (Epic): The coordinator or designated SON contact will provide you with HealthStream credentials and instructions to complete the lessons and associated competency examination; submit certificates of completion to obtain your network login username and password. 
  • Glucose Meter (AccuChek Inform II)
  • Review the Student Badge Process and PPMC ParkingPSVMC Parking information