Facility Specific Documents
Documents will be submitted directly to your clinical teaching assignment. If you need the academic liaison's contact information, please contact the clinical placement team at clinicalplacement@fullerton.edu .
File type and sizing are important. We encourage faculty to scan Facility documents into one PDF, ideally keeping your document packet to a minimium file size of 2MB or less. A scanner is available for convenience at the Nursing Simulation Center Student Library. In addition, you can use these scanners to automatically convert images to PDF’s depending on your phone’s operating system: IOS Guide / Android Guide
Anaheim Regional Medical Center (AHMC)
- AHMC Check-Off Sheet
- AHMC Registry and Student Orientation Guidelines
- AHMC Post-Test
- AHMC Answer Sheet
- AHMC Statement of Confidentiality
- AHMC Statement of Responsibility and Orientation Acknowledgement
- AHMC Systems Access Request Form
- AHMC Evaluation forms
Children's Hospital Los Angeles (CHLA)
Children's Hospital Orange County (CHOC)
Corona Regional Medical Center (CRMC)
UCI Health- Fountain Valley
- UCI FV Check-Off Sheet
- UCI FV 2024 Orientation
- UCI FV Student Nurse Co-Signing Process
- UCI FV Confidentiality Agreement
- UCI FV Security Form and Contract Personnel
- UCI FV Information Privacy and Security Education Attestation
- UCI FV COVID Attestation
- UCI FV Orientation Information Acknowledgment
- UCI FV Artificial Nails Policy
Kaiser Permanente (KP)
If you have not yet been assigned an NUID number, please leave this area blank on your KP forms when asked for an Employee ID or an NUID.
Kaiser Permanente Los Angeles
- Check-Off Sheet for KP LA - rotation clinical teaching assignment (BSN / Undergrad students)
- KP LA Student HR Forms
Kaiser Permanente Orange County - Anaheim and Irvine sites:
- Check-Off Sheet for KP OC - rotation clinical teaching assignment (BSN / Undergrad students)
Kaiser Permanente San Bernardino County- Fontana and Ontario sites:
- Check-Off Sheet for KP SB - rotation clinical teaching assignment (BSN / Undergrad students)
- KP Learn Modules Instructions
Kaiser Permanente Downey:
- Check-Off Sheet for KP Downey- rotation clinical teaching assignment (BSN/ Undergrad students)
- Health Status Information
- KP Downey Student HR Forms
UCI Health - Los Alamitos
- UCI LAMC Check-Off Sheet
- UCIMC Confidentiality Form
- UCI LAMC Orientation Packet
- UCI LAMC Student Sponsor Form
- UCI LAMC Student Test
- UCI LAMC Student Attestation
- UCI LAMC 2025 Privacy and Security Training
- Acknowledgement of UCI Health Privacy and Security Training
Mission Hospital
Orange Coast Memorial Medical Center (OCMMC)
- OCMMC Check-Off Sheet (Review check-off sheet to access all OCMMC documents)
UCI Health - Placentia Linda
- UCI PLH Check-Off Sheet
- UCI PLH Orientation Booklet
- UCI PLH Student Sponsor Form
- UCI PLH Student Test
- UCI PLH Student Attestation
- UCI PLH COVID-19 Declination Form
- UCI PLH Confidentiality Agreement
- UCI PLH 2024 Privacy and Security Training and Acknowledgement Form
Pomona Valley Hospital (PV)
- PV Check-Off Sheet
- PV Hospital System Access Request Form
- PV Confidentiality Statement
- PV Basic Orientation and Acknowledgement
Riverside County Department of Public Health (RCDPH)
Saddleback Memorial Medical Center (SMMC)
- Saddleback Check-Off Sheet
- Student Agreements
- Orientation Acknowledgement Form
- Epic Training Instructions
- Contact Staff and Student Hospital Booklet
San Bernardino County Department of Public Health (SBCDPH)
Please ensure to review all items below:
- SBCDPH Check-Off Sheet
- Transportation of Protected Health Information Report
- Acknowledgment Form</a (Page 4 of PHI Report above. Print out and complete.)
- Volunteer Services Program (VSP) Packet
- Important! All faculty are required to come in person to the School of Nursing main office in EC-190 to pick up their Life Scan Voucher. Due to strict policy per SBCDPH, these vouchers cannot be mailed and must be distributed in person. Please bring a valid, current form of ID when picking up your Live Scan Voucher at the front desk.
St. Joseph Hospital (SJH)
St. Jude Medical Center (SJMC)
UC Irvine Medical Center (UCIMC)
- UCIMC Check-Off Sheet
- UCIMC Confidentiality Form
- UCIMC Nursing Student Orientation
- UCIMC Keeping Family Safe If You Have COVID-19
- UCIMC Monitoring Yourself for Infection Symptoms
- UCIMC Concerns About COVID-19 Exposure
- UCIMC Campus Map
Veterans Affairs, Long Beach (VALB)