Important Forms and Dates
As a participant in the HTE@USC Program, you will need to be compliant with all health requirements for the Keck School of Medicine. Below you will find documentation listing all required immunizations. At your earliest convenience, please make an appointment with your healthcare provider to begin the health clearance process.
In order to obtain your ID badge for USC LAC and health clearance for ICM you must:
- Print out the forms listed below
- Complete the forms in full
- Email completed forms to: firstname.lastname@example.org or fax forms to: 323-442-2663
If you are utilizing the USC Engemann Student Health Center, go directly to the Immunization Center (no appointment needed) for assistance. You can also check with the USC Eric Cohen Student Health Center website to make certain your health clearance is in compliance. Go to http://ecohenshc.usc.edu/ and click “Patient Login” below My SHR. If your record shows you are non-compliant, immediately contact the Eric Cohen Student Health Center at 323-442-5631. Monique Abeyta in Keck Student Affairs will email you when your LAC+USC ID badge is ready for pick-up.
Once you are compliant with all health requirements, a physician or a licensed healthcare professional must complete and sign section I of the E2 form.
Be advised that you are to complete the asterisk sections on the E2 form.
Please return completed forms to email@example.com or fax 323-442-2663.
The Office of Student Affairs will complete section III on the document and forward a copy to the LAC USC Employee Health office. The E2 health form is required for issuing your LAC USC badge by the LAC USC Employee Health office.
- 2014 HIPAA Privacy Notice
- 2014 Immunization Requirements
- 2014 LAC USC E2 Form
- 2014 Tuberculosis Screening Questionnaire
All LAC USC completed forms should be sent to firstname.lastname@example.org or fax 323-442-2663.
In order to obtain access to CHLA you must:
For HTE@USC students that are shadowing clinicians at CHLA and observing patient areas, please complete the CHLA Hospital Policy Forms below and return them to email@example.com.
- Student Placement-Observation and Job Shadowing-Tours of Patient Attachments 23 1 to 23 6
- Student Placement-Observation and Job Shadowing-Tours of Patient CC 23 0
Policies, Procedures, Requirements, and Expectations for HTE students
Calendar and Holiday Schedule
The program will observe the official university holiday schedule (unless otherwise notified).
Change in Student Status
Please notify the HTE Office of any change in your status as part of our tracking and evaluation process.
Sexual Harassment Hotline
Information, counseling, referral or other assistance regarding the university’s sexual harassment policy or concerns about sexual harassment in the classroom or workplace is available by contacting the Office of Equity and Diversity http://policies.usc.edu/policies/complaint/sexharassment070108.pdf.
The University has mechanisms in place to assist students with disabilities. Please contact the Disability Services and Programs (attn.: Director: Edward Roth, Ph.D./Associate Director, Mattie E. Grace, Ph.D.) at (213) 740-0776/ (213) 740-6948 (TDD only), or at firstname.lastname@example.org. They are located at University of Southern California, Student Union 301, Los Angeles, CA 90089-0896. Please refer to their website for further assistance at http://sait.usc.edu/academicsupport/centerprograms/dsp/home_index.html.