Get Communicare Health Centers Student And Resident Rotation Intake Form 2018-2025

Filling out the CommuniCare Health Centers Student And Resident Rotation Intake Form is an essential step in ensuring a smooth rotation experience. This guide provides clear, step-by-step instructions to help you complete the form online with confidence.

Follow the steps to fill out the form online effectively.

1. Click the ‘Get Form’ button to access the form and open it in your preferred online editor.
2. Fill in your personal information, including your first name, last name, and preferred pronoun. Be sure to include your birth date, address, city, state, zip code, preferred phone number, and email address.
3. Indicate whether you are 18 years or older by checking the relevant box, as this is required for access to patient charts.
4. In the education and rotation information section, select the option that best describes your status, such as MSW student or medical resident. If applicable, specify 'other' and provide details.
5. Complete the details regarding your name of school or program, faculty contact, phone number, and email address.
6. Identify your preceptor or supervisor at CommuniCare and indicate which CommuniCare site(s) you will be located by checking all that apply.
7. Enter your intended start and end dates for the rotation.
8. Fill out the emergency contact information, including the full name, relationship, and phone number of your emergency contact.
9. Read and understand the statement regarding the accuracy of the information provided. Proceed to provide your handwritten signature and the date.
10. After completing all sections, ensure your information is accurate and then save your changes. You can download, print, or share the completed form as needed.

Complete your CommuniCare Health Centers Student And Resident Rotation Intake Form online today!