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 on the Cover Sheet in Step 4.

STEP 2:  Complete and return each document. 

STEP 3: Provide the following documentation

  • Letter of Good Standing from your school
  • 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
  • Flu Vaccine for current season.

STEP 4:  Print required Cover Sheet 

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

Joyce Donohue
Medical Student Education Coordinator
Office:  845.368.5585
Fax:  845.368.5938