Medical Staff, Clinical Rotation Students Process

Welcome to the Bon Secours Charity Health System, Medical Staff Services Department. We sincerely hope that you have an enriching experience with us. Please make sure that all appropriate paperwork is completed as directed below. We look forward to meeting you.


All Clinical Rotation students must return the required paperwork to the Medical Staff Office 4 weeks prior to their rotation. After the paperwork has been submitted, kindly contact the Onsite Clinical Director to discuss your start date.  Please complete the following steps:

STEP 1: Review all documentation below and provide confirmation in the Cover Sheet within the Clinical Rotation Application form packet under Step 2.

STEP 2:  Complete and return the Clinical Rotation Application forms.  ***NOTE:  Please DOWNLOAD the PDF and open it with Adobe to be able to sign ***

STEP 3: Provide the following documentation

  • Letter of Good Standing from your school
  • Most recent physical examination report including immunization details
  • PPD Results (within one year)
    • If PPD positive, a Chest X-Ray report must be included
  • Rubella Titre
  • Rubeola(Measles) Titre, if born after 1/1/57
  • Proof of Flu Vaccine if clinical rotation is between September - April (submit the provider sheet which includes the lot #, provider details, etc.)

Submit ALL required paperwork via Email or Fax

A representative from Bon Secours Charity Health System will contact you after receiving your paperwork.

Submit all forms to: Good Samaritan Hospital

Medical Student Education Coordinator
Office:  845.368.5585
Fax:  845.368.5938