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List of required documentation to be submitted by Faculty member to VA HR:

1. VHA form 10-2850a
2. Resume
3. OF-306
4. Transcript
5. Certifications

In addition to the above documentation, Nursing Education requires the following forms to be completed and submitted:

1. Clinical Instructor Profile
2. Faculty cover and checklist
3. TMS completion certificates
4. Test for student education

Upon Completion of Clinical

Clinical instructors must collect two forms from the students upon completion of clinical:

1. National VA Learners’ Perceptions Survey  
2. Atlanta VAMC Student evaluation form

Both forms must be submitted to Jeanne L. Overby within 3 days of completion of clinical.  You can e-mail jeanne.overby@va.gov or fax 404-728-7733.  Please email Jeanne when you fax the documents, the fax machine is not in her office.

• No special requirements.

• No special requirements.

• No special requirements.

Please remember that any new instructors to Children's must have all of their orientation requirements completed prior to starting on the unit with their students.

New pediatric faculty please contact Linda Sutton, KSU clinical faculty coordinator. Her contact information is lsutton7@kennesaw.edu, 470-578-6671. Do not submit materials or contact CHOA until you speak with Linda Sutton. She will help you with the process.

1. If you have been assigned to CHOA you will complete a clinical instructor request form. This form can be accessed via a link sent to you from Linda Sutton. Once this link is completed you will receive an e-mail from Symplr. Credentialing for CHOA will cost $49. Send your receipt to Lisa Longeiret llongeir@kennesaw.edu for reimbursement.
2. If you do not receive Symplr’s e-mail please contact Lisa Longeiret  llongeir@kennesaw.edu. 
3. Please read Symplr’s instructions carefully, detailed information is listed for required uploads and documentation.
4. Manager should be listed in Symplr as Lisa Longeiret llongeir@kennesaw.edu 470-578-6061
5. CHOA does their own background check through Symplr, you can print your drug screen from Advantage Students and upload the results to satisfy the drug test requirement.
6. CHOA encourages you to download the Symplr Mobile App (after connecting to their site you can upload required documents and it will provide you with real time compliance status).
7. Symplr will show green light status when you have completed each portion of credentialing.
8. Once this is complete, you will receive an email from CHOA to attend a Patient Care Provider Orientation (PCPO). Any clinical instructors who are not current CHOA employees are required to attend.
9. For instructors without previous EPIC experience, an 8-hour class will be required prior to the start of clinical. For instructors with previous EPIC experience a "test out" option will be offered.
10. All clinical staff are required to complete an annual OEA CBT that will be assigned through Workday.
11. All instructors are required to complete an 8-hour shift on their assigned unit.  This can only be scheduled once clearance is given from CHOA. This orientation is be completed no later than 2 weeks prior to start of clinical.

Badges:

• You will receive information via email about your badge pick-up process from CHOA.

In the event you have an issue with one of the requirements please contact Lisa Longeiret llongeir@kennesaw.edu for resolution

• Faculty should contact Cynthia Appleby for scheduling student orientation or other coordination issues at 770-514-3118 or clappleb@dhr.state.ga.us.

*when signing up with ACEMAPP only use your KSU e-mail*

Emory is now using ACEMAPP as their credentialing tool. You will receive an e-mail invitation to join this credentialing tool (KSU e-mail address). If you do not receive this invitation please contact llongeir@kennesaw.edu. The required documents will be in ACEMAPP.

For help with the ACEMAPP, please contact their support team below:

• Email: support@acemapp.org
• Phone: 844-223-4292

Parking / Badge Information

Emory University Hospital Midtown Only:
Badge office hours are M-F 7-3:30 (closed for lunch from 12:30-1:00), located on the F level of the Glenn Building (adjacent to the visitor parking deck).
Students are required to find parking in other pay lots. There is a lot at the corner of Peachtree and Pine for $5 per day if in by 9:00 a.m.

Floyd Medical Center uses ACEMAPP as their credentialing tool.  Review requirements for Floyd Medical Center in ACEMAPP. 

For help with ACEMAPP, please contact their support team below 

Email: support@acemapp.org 

Phone: 844-223-4292 

• No special requirements.

• No special requirements.

• No special requirements.

• Attend Grady Faculty Virtual Orientation. Faculty and students register for Grady Orientation through ACEMAPP on the events tab. Directions/information regarding this process (and GO in general) is located on the Student & Faculty announcement tab.

*when signing up with ACEMAPP only use your KSU e-mail.

1. Complete all required documentation and log in frequently to assess your
   progress. If you do not receive an invitation please e-mail
   llongeir@kennesaw.edu
   
   
2. Log into your Advantage Students account by clicking the Vendors tab in ACEMAPP.
   Select Grady Health System to share your reviewed results
   
   
3. All students will be required to pay $1.00 badge fee to Grady Hospital before
   receiving their badge. Community and Practicum Students, badges must be picked up
   no sooner than 3 days prior to the beginning date of your clinical rotation, you will be
   unable to begin your rotation without your badge.
   
   
4. Parking is $6.00 a day

Health Clearance Requirements for Grady

All requirements will be listed in ACEMAPP

Please see Floyd Medical Center

Intern On-board Packet

• Faculty please complete the Intern On-board Packet and e-mail it to llongeir@kennesaw.edu two weeks before orientation.
• There is a required in-person orientation for this site. The date and time will be given at placement or once documents are submitted.
• If you do not receive a orientation date one week before clinical, please contact your clinical faculty for orientation.

• No special requirements.

Since the KSU Health Clinic is now part of the WellStar Health System, see WellStar Health System (Kennestone, Cobb, Windy Hill, Paulding, Douglas and First Steps) below and follow the instructions.

• No special requirements.

*when signing up with ACEMAPP only use your KSU e-mail*

Northside is now using ACEMAPP as their credentialing tool. You will receive an e-mail invitation to join this credentialing tool (KSU e-mail address) about one week after you are notified of your placement. If you do not receive this invitation please contact llongeir@kennesaw.edu. The required documents will be in ACEMAPP and the deadlines for completion will be listed on the ACEMAPP site.

For help with the ACEMAPP, please contact their support team below:
Email: support@acemapp.org
Phone: 844-223-4292

• Immunizations needed for clinical at NSH
  • TB (submit proof of two consecutive negative TB results):
    • Negative PPD: Negative PPD within 12 months and a PPD within 60 days prior to clinical start date OR 2 annual negative PPD’s
    • Positive PPD:  Negative Quantiferon Gold within 60 days prior to clinical start date (May also need a CXR if in high risk area like OB)
    • Positive Quantiferon:  Negative Annual Chest X-ray with report read and signed by MD
    • Positive Chest X-Ray:  Need evidence of INH or Rifampin treatment and negative Chest X-ray within one year of placement
    • See attached flow chart for your particular situation. 
  • Proof of tetanus immunization
  • Proof of Varicella or titer value report
  • Proof of two MMR immunization or titer value report
  • Proof of three Hepatitis B immunization or titer value report

Parking and Badges 

• NSH-ATL: all students and faculty are to park at the Orange Parking Deck
• NSH-CHER: senior practicum students ONLY, please pick up badges from Toni McPherson once you receive clearance for all requirements in ACEMAPP. Call (678-388-6404, 7:30 to 4:00) to make an appointment for badge pickup.

Northside Hospital
Contact: Ms. Maryam Frazier
Phone: 404-843-4133

Address
Northside Hospital
1000 Johnson Ferry Road NE
Atlanta, GA 30342-1611

For 4417 senior practicum students and faculty supervised instructors – pick up your badges from Northside AFTER you have been cleared to begin, but BEFORE reporting to your unit. 

Northside Clinical Education
Interchange Building
5780 Peachtree Dunwoody Road,
Atlanta (30342 for GPS)
Suite 500  (5^th floor)
Hours:  7:30 am – 4:00 pm (M-F)

Use the white phone in the lobby to call extension 5577 to let us know you are here. 

1. Go to .
2. Read and follow the instructions to access your credentialing documents.

Badge Pickup

• Badges must be picked up from HR (open 8:00 a.m. – 4:00 p.m.) before rotation begins. 

Medical Documents 
(must be submitted with your clinical paperwork)

1. Front and back copy of your current CPR card
2. Immunizations
   • PPD (Must provide one of the following)
     • Negative PPD: Negative PPD within 90 days. If your PPD is not within 90 days Cartersville Medical Center requires you to have another test administered. Contact your Personal Health Care Provider or you can have the test done at the KSU Clinic, the cost is $17.00 (may be less depending on insurance) / call 470-578-6644 to schedule an appointment (The updated PPD must be submitted with your clinical paperwork).
     • Positive PPD: Chest X-ray or radiology report within the last 12 months and documentation of taken prophylactic medication
     • Quantiferon: Must be negative result
   • Proof of tetanus immunization
   • Proof of Varicella or titer value report
   • Proof of two MMR immunization or titer value report
   • Proof of three Hepatitis B immunization or titer value report
   • Current Flu documentation

• No special requirements.

• No special requirements.