Southern Regional Medical Center


Student Information

  1. Review Clinical Information & Safety Manual
    • Sign page 242
  2. Complete Badge Request Form
    • Badge Type: Student/Intern
    • First & Last Name
    • Dept. Assigned to: Enter Assigned Unit
    • Length of Contract: Enter clinical start and end dates
    • Organization Name: WellStar School of Nursing
    • Contact: Lillian Valdez/ Administrative Associate I
    • Address: 1000 Chastain Road, Kennesaw GA, 30144 MD4102
    • Phone: 470-578-2890
  3. Read and Sign the SRHS Confidentiality and Nondisclosure Statement
    • Employee or Affiliate Signature: Sign Name and date
    • Employee or Affiliate Print Name: Print Name
    • Immediate Supervisor and date: Leave Blank
    • Employee or Affiliate SSN: Your Social Security Number
  4. Complete State and Federal Criminal Background Check and Ten Panel Drug Test
    • MUST BE WITHIN ONE YEAR OF CLINICAL
    • You will need to purchase another background check/drug test from Advantage Students if your background is older than one year
    • Release results to Southern Regional Health System
  5. Must have current AHA CPR card on file
  6. Must have current PPD Skin Test or Chest X-ray (if PPD positive)
    • PPD/ CHEST X-RAY MUST CURRENT WITHIN ONE YEAR
  7. Seasonal Flu Shot
    • Must be submitted before November 5th of each year.
    • Required November 5th through March 31st of each year
  8. Print and Review  the Student Checklist for File

Accessing Instructor and Student Badges to SRMC:
Make an appointment with the Education Department at 770-991-8329 or 770-991-8133

 

SUBMIT ALL FORMS TO Lillian Valdez IN ROOM 3004 OR lvaldez2@KENNESAW.EDU