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Required documentation

Documentation for Pediatrics rotations at Advocate Christ Medical Center/Advocate Children’s Hospital – Oak Lawn, should be submitted to: Tammi Bauske, Tammi.Bauske@aah.org. PDF documents are preferred.

Required Forms

Once a scheduled rotation confirmed, the following forms and information must be received by the Medical Student Office a minimum of four (4) weeks prior to the rotation start date. Information should be submitted via e-mail (Tammi.Bauske@aah.org). Please do not submit paperwork until you have received confirmation of a scheduled rotation.

Rotation Paperwork Check Lists

RFUMS-CMS, U of I-Chicago, and Midwestern-CCOM Students:

  • Medical Student Information Form (link to PDF)
  • TB Questionnaire (for students with positive PPD/QFT only) (link to PDF)
  • Student Video Attestation (link to PDF)
  • Professional/white coat headshot photo for ID badge (JPEG format only, please)

Students of all other schools:

  • Medical Student Information Form (link to PDF)
  • Medical and Immunization Clearance Form (link to PDF)
  • TB Questionnaire (for students with positive PPD/QFT only) (link to PDF)
  • Letter of Good Standing (details below)
  • Student Video Attestation (link to PDF)
  • Professional/white coat headshot photo for ID badge (JPEG format only, please)
  • COVID Vaccine Verification Form (*To be submitted separately, see directions below.) (link to PDF)

Onboarding Documentation Instructions

Medical Student Information Form

  • Must be completed for EVERY rotation scheduled at an Advocate Health facility.

Medical and Immunization Clearance Form

  • TB Test – If TB test expires during a scheduled rotation, an updated test is required prior to the rotation start date. Positive TB test (>9) requires proof of negative chest x-ray (must be dated after positive TB test) and TB Questionnaire (must be completed for every rotation).
  • TB Questionnaire (for students with positive PPD/QFT only)
  • Mask Fit Test - Every student rotating on a clinical service must be fit tested for a Technol N-95 TB mask. The test date and mask size must be indicated on the medical clearance form.
  • Vaccination/Immunity Status - Student must indicate the date of the immunity titer and circle the result. If no titer, please indicate vaccination dates as listed.
  • Flu Vaccine – Students are required to be vaccinated for the current flu season for the rotation start dates from October 1 – April 30.
  • Students are required to sign the form to verify the accuracy of the information.

Letter of Good Standing

  • Must be on University/Medical School stationery and be signed by the Office of Student Affairs.
  • Must verify student academic status, the medical school’s approval/authorization of the named elective and rotation dates, and the student evaluation requirements.
  • Must include verification of the following:
    • Criminal Background check
    • OSHA/Universal Precautions training
    • HIPAA training
    • BLS/CPR training
    • Student health insurance coverage
    • Malpractice/liability insurance in the required minimum amounts of $1 million per occurrence/$3 million aggregate

Student Video

COVID Vaccine Verification Form

  • Must be completed for the first Advocate site rotation of each academic year. Your information will be retained for subsequent rotations. Updated information may be requested as needed. Please note, this must be sent to ahc-mededcontracts@aah.org with a copy (CC) to the coordinator (Tammi.Bauske@aah.org) and not returned with your other onboarding documentation.