Required Documentation

Important: These required documents, along with the completed application, must be received by our office no later than four weeks before the start date of the clerkship at the University of Wisconsin School of Medicine and Public Health. Applications filed less than 30 days prior to the beginning of a course will not be considered.

HIPAA

As a student in a clinical training program in the health care component of the University of Wisconsin-Madison, you are required to learn about the health information privacy requirements of HIPAA (Health Insurance Portability and Accountability Act).

Please read the HIPAA Training Document. Then, print, sign, date and submit the confidentiality agreement with your application.

Immunization Status Form

Please print the Immunization Status Form (doc). Attach copies of your Immunization lab reports/titers (see item No. 1) and include this information in your application packet. Do not send copies of your childhood immunization dates or titer summaries from your school. Only the UW immunization status report with copies of your lab reports/titers will be accepted.

Background Information Disclosure

Under the authority of the Wisconsin Caregiver Law, completed background information disclosure forms are required of all visiting students receiving clinical training at Wisconsin health care facilities. The information obtained on this form will be used by our clinical training facilities to determine your eligibility to train within the facility. A completed Background Information Disclosure Form (pdf) is required of all visiting students regardless of their place of residence.

Please note: If you answer yes to Question 3 in Section B ("Have you been discharged from a branch of the US Armed Forces, including any reserve component?") you must submit a copy of your discharge papers (DD214).

Safety and Infection Control (SIC)

To ensure that safe, high quality patient care is provided at University of Wisconsin Hospital and Clinics, all visiting medical students are required to successfully complete the UW Hospital and Clinics Safety and Infection Control (SIC) training.

Mastery of the course content is demonstrated through an examination. An exam score of 100 percent is required to pass the course.

The course is accessible through UW Health's e-Learning Web Site. Log in using "student" as the enrollment key. Read the manual, take the exam, print the certificate and include it in your application packet.

For assistance with the Safety and Infection Control (SIC) training, contact the UW Health e-Health office at ehealth@uwhealth.org or the UW Hospital and Clinics help desk at (608) 265-7777.