Alameda Health Systems

The documents should be ordered in ONE PDF in this order:

• ID Badge Form (signed second page only – please indicate date as one month before start of rotation).
• AHS Covid Attestation.
• AHS orientation handbook acknowledgement form only (signed, please indicate date as one month before start of rotation).
  Supervisor Name: George Lee, OD.
  Phone: (510) 642-9677.
  Department Where You Will Work: Optometry.
  For Campus, circle either ‘Hayward Wellness Clinic” or “Eastmont Wellness Center.”
• AHS Student confidentiality and security agreement only (signed, please indicate date as one month before start of rotation).
• AHS privacy and confidentiality handbook form only (signed, please indicate date as one month before start of rotation).
• Cleared criminal background check letter (ONLY the one page background check clearance/results letter. DO NOT include the three Livescan forms that you FAX to UCPD)/
• Immunization documents (see specifics below in immunization section, G).

• If you do not have your badge by the first day of your AHS rotation and are unable to see patients, you will accrue three (3) debit days for each day that you miss clinic.
• Class of 2023 – All AHS ID Badges will need to be turned into Clinic Admin during Old Home Week in May 2023 and will be returned to AHS.
• Please note that all fees for training/checks/testing that are associated with the clearance process will be at student expense. Once you have completed the clearance and received your ID badge, it is valid for Eastmont and Hayward locations. Therefore if you are attending any of these clinics but during different sessions, you only need to go through the clearance process once. Additionally, once you have your ID badge, you may substitute for other clinicians at Eastmont or Hayward on an as-needed basis for clinic credit.
• Please note that even though AHS clinic need immunization records for onboarding, the office of record for your immunizations in the Admissions and Student Affairs Office (ASAO). Please make sure they also receive a copy of any new immunization documents you obtain.
• When you have completed your clearance and have obtained your ID badge, please notify all of the following:
  Liz Doty: elizabeth.doty@berkeley.edu,
  George Lee: gkl@berkeley.edu and
  Vikki Yu: vyu@berkeley.edu.

• You will need to complete the fingerprinting for a background check done via a Live Scan process if you are in the state of California. This requirement will check the FBI and California Department of Justice (DOJ) databases (in addition to obtaining the following information: Sex Offender Registry, OIG/GSA, SSN Address Locator and County Criminal databases).
• It is recommended to do the fingerprinting during the session or two immediately prior to the session when you attend AHS. However, if you are on out-of-state externships for two sessions before your AHS session, please do the fingerprinting between one to two weeks before you leave the state of California. Allow a one-week window before you leave the area to be able to complete re-prints at if needed.
• If you are attending BOPC, Travis Air Force Base AND Alameda Health Systems (and the rotations are within six months of each other), please follow the fingerprinting instructions under Alameda Health Systems requirements. Background check results will be kept on file in Clinic Admin, but must be completed and on file SIX to EIGHT weeks before the start of your either your BOPC, Travis AFB or AHS rotation. The background check must be completed by the earlier of the three deadlines for AHS, Travis AFB or BOPC.) Please note that a background check done on mybackgroundcheck.com (acceptable for BOPC or Travis AFB) WILL NOT be acceptable for Alameda Health Systems (must be done via Livescan).
• If you are attending Over 60s and Alameda Health Systems (and the rotations are within six months of each other), please follow the fingerprinting instructions under Alameda Health Systems requirements. Over 60s will accept a background check if done within a year of when you start. However, AHS will accept background checks done within 6 months so please consider the timing of when to get your background check. Background check results will be kept on file in Clinic Admin, but must be completed and on file SIX to EIGHT weeks before the start of your either your Over 60s or AHS rotation. Please note that a background check done on mybackgroundcheck.com (acceptable for BOPC, Over 60s or Travis AFB) WILL NOT be acceptable for Alameda Health Systems (must be done via Livescan).

Proof of Covid-19 vaccines and booster.

• Current 2-Step PPD skin test (TST) or IGRA –blood test (QFT or T-Spot). Test must be done within 12 months of obtaining clearance and not to expire during your rotation. Date of last 2-Step PPD test administered, must show annual TB surveillance with no lapse in time. If known positive, must show chest x-ray (within past 4 years, must also include documentation of positive TST history and a current TB Symptom Survey).
• 2-Step PPD Test: The two-step test is NOT the usual PPD skin test in which you receive an injection of PPD and the test area is observed one time at specific time frame. The two-step PPD test is used to detect individuals with past TB infection who now have diminished skin test reactivity or to offset potential false negative testing results. This procedure reduces the likelihood that a boosted reaction is later interpreted as a new infection. Step 1 is a TB test done within the last year. The second TB skin test must be completed at least one week after the first TB skin test. Step 2 is a negative TB test done within the last three months. If the second test is negative, the person is considered uninfected. If the second test is positive, then the person is considered to have a “boosted” reaction to an infection that occurred within 12 months.
• For those whose last TB test is over one year ago, please follow this 2-Step PPD Test. In this procedure a person is given a baseline PPD test. If the test is negative, a second test is administered one to three weeks later. If the second test is negative, the person is considered uninfected. This two-step PPD will require four visits.

Proof of TWO (2) vaccines, and or positive titers.

Proof of Hepatitis B vaccine series, positive titer or declination.

If you have not done within ten years, you may need a T-Dap vaccination or you can opt out by completing a declination form, linked below. If you wish to opt out, please complete the form and include with your documents.

During Flu season, must show proof of flu vaccine. Flu vaccine should be received between October 1st and March 31st, but preferably around October 1st. Please include documentation if you are going to AHS during Fall 1, Fall 2, Spring 1 and Spring 2 rotations.

• You may want to obtain your immunization records from ASAO. If you are missing any immunizations, please see your primary care provider, the Tang Center or have the immunizations done at AHS.
• Please see AHS Immunization Health Screening Requirement and Price Sheet. This form provides the fee schedule for immunizations in the event that student or instructor would like to have services administered at Alameda Health System.
• At AHS, please be sure to arrive 15-20 minutes earlier than your appointment. You will need to go to the E Building at Fairmont Campus and pay prior to your immunization procedures. They accept Credit Card, Checks and Cash.

• A State Issued ID, Passport or School ID.
• Provide both completed signed forms: Clinical Experience Requirement form (signed by Dr. George Lee) and ID Badge Form (signed by Dr. George Lee).

If you have any questions about the process and requirements, you may contact Dr. Yu or Jaya Iyer, HR Service Representative, (510) 346-7543, jaiyer@alamedahealthsystem.org.