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Office of Student Affairs
1682 SOM Education Building
Riverside, CA 92521
Dear Class of 2019,
All UCR medical students are required to complete the Kaiser Permanente compliance paperwork that is necessary
for entrance into any Kaiser medical facility for the LACE Program and other clinical rotations and shadowing
experiences (Riverside, Corona, Moreno Valley, Palm Springs and Fontana). For your convenience, attached are the
required forms and informational documentation for you the complete, sign and return to Cheri Black in the Office
of Student Affairs prior to the first day of orientation, Monday, August 3, 2015. You are welcome to complete
the packet and email or fax it to Cheri, and then follow up with the hard copies on August 3, 2015. Cheri’s e-mail
address is cheri.black@ucr.edu and her fax number is (951) 827-5504. You are required to read and comprehend
the informational documents describing the policies, terms, and conditions as well. Along with the paperwork, you
must submit a copy of a photo ID (driver’s license or identification card).
Kaiser also requires copies of your health clearance forms, and certification of Basic Lifesaving/CPR training.
Please note, these two documents will be sent to Kaiser by the Office of Student Affairs after you complete your
BLS/CPR training during orientation week. We have a contract with Kaiser; therefore, the Letter of Good
Standing and the Professional Liability letters are not needed.
Packet # 1 contains information that you must read and keep for your records. You will also need the SOS and
Infection Control newsletters in this packet to complete your SOS and Infection Control post-tests. You don't have
to print these pages unless you want to.
Packet #2 contains required forms and a checklist that indicates the immunization and other documentation that is
needed. Leave the Employee number blank on the forms that request one because you don't have one, and leave the
department name blank or insert "Various."
On the checklist you will notice at the bottom of this page "Annual Compliance - Online Training". Once we have
received your completed documentation mentioned above, Kaiser will order a KP Learn account for you. You will
receive an email from KP Learn with a password and then you will be able to logon and complete your online "2015
Annual Compliance Training". Please be sure to print out your Certificate of Completion and send it to Cheri
Black in the UCR School of Medicine Student Affairs Office. Once we receive your certificate, Kaiser will
process an order your ID badge to display during hospital visits.
Again, all the items in the checklist and the documents are due on the 1 st day of Orientation on Monday, August 3,
2015.
Please contact Kaiser if you have additional questions:
Holly A. Miller, MBA
Administrative Specialist
Graduate Medical Education Department
Kaiser Permanente - Riverside
11080 Magnolia Ave.
Riverside, CA 92505
Ofc: 951-602-4055 or tieline 8-265-4055
Fax: 951-602-4145 or tieline 8-265-4145
Email: Holly.A.Miller@kp.org