Dominican Hospital Family Medicine Subinternship – Onboarding Requirements Checklist

• Copy of ID (Driver’s License or Passport)
• CV
• Letter of Good Standing
• Photo (in jpg format)
• Certificate of Liability Insurance
• Physical or Current History (done within last 12 months of clerkship)
• Background Check (done within last 12 months of clerkship)
• HIPAA Training Certificate of Completion
• Blood Borne Pathogens Certificate of Completion
• Proof of COVID Vaccination/Booster
• ACLS or BLS Card
• Proof of Health Insurance
• 10 Panel Drug Screening (done within last 12 months of clerkship)
• Vaccination Record
• Seasonal Flu Vaccine (done within last 12 months of clerkship)
• TB Clearance (done within last 12 months of clerkship)
• Personal Data Form
• TB Prevention Training
• Hand Hygiene Training
• Traveler Orientation Packet
• Traveler Orientation Self Quiz
• Workplace Violence Prevention Awareness Packet

To remain compliant with CommonSpirit regulations, please provide one of the following to satisfy your physical onboarding requirement:

• A progress note from a primary care visit within 12 months of your subinternship OR

• A letter from a licensed healthcare provider stating that you are in good mental and physical health and are not currently experiencing any illness or condition that would affect your ability to work directly with patients.
  
  “I have examined [name] and to the best of my knowledge; he/she is in good mental and physical health, and is not suffering from any current illnesses/ailments that may hinder his/her ability to work with patients directly.
  
  By signing below I certify that the above information is true.”