Kaiser – Daly City (Daly City, CA) – KAISER – DALY CITY
- Please complete the “Affiliated Nursing Checklist” as best as possible.
- Instructor Name: Chris Wilmer, OD
- Course Name: UC Berkeley Optometry
- Days of Week: Monday through Friday, 8 a.m. to 5 p.m.
- Enter dates of immunizations or requirements completed (such as Background Check, BLS (Basic Life Support)
- You do not need to enter anything under:
- KPHC Training
- KP HIPAA Training
- Annual Compliance Certificate of Completion
- Liability Insurance
- Provide copies of the following in ONE pdf to Dr. Yu with the completed Affiliated Nursing Checklist as the first page. Dr, Yu will check them before you send them to Nurse Stacey Liu:
- Affiliated Nursing Checklist
- CPR certification required
- Background Check
- Drug Screen results
- Varicella – two doses
- Current PPD – must have 2 within last 12 months or chest x-ray
- MMR – must have 2 vaccinations
- Hepatitis B
- TB – skin or blood test okay
- Covid-19 vaccine and booster is required. No religious or medical exemptions are permitted.
- No physical exam is required
Immunizations Records Submit to and Date:
- Due SIX WEEKS prior to start date.
Send via mail or email: Stacey Liu, TPMG Nursing Educator, Kaiser Permanente South San Francisco, 1200 El Camino Real, South San Francisco, CA 94080, Office (650) 742-2095, Email: Stacey.A.Liu@kp.org
Drug Clearance – All students need to obtain a drug clearance via a urine test. If you have SHIP insurance, it is possible for you to have the drug testing done at the Tang Health Center. Please contact Drs. Harry Green (email@example.com) or Chris Wilmer (firstname.lastname@example.org) to place an order for your drug testing. Your SHIP insurance will cover the cost of the drug testing, but there may be a copay.
Otherwise, Any SHIP student can make an apt at Tang in primary care and simply tell the clinician why they need the drug screen (urine test) it could be ordered for them. You might even be able to send a message to your primary care provider with this type of request. You can also ask the SHIP office/lab directly what the co-pays are for the tests.
Non-SHIP patients can do the same, as you are able to obtain services at Tang, but it will cost a lot more. Again, you can call the SHIP office /lab directly to find out.
As an alternative, if you do not have SHIP insurance, please contact your primary care physician and to see if they can order a urine drug testing for you. Otherwise, we will try to set up the drug testing with Concentra Occupational Health Centers. Please inquire with Liz Doty or Dr. Yu for information.
Fingerprinting Protocol (effective July 2, 2022):
Below are the steps and what you need to know to schedule your fingerprinting appointment with UC Berkeley’s fingerprint service provider, Biometrics4ALL, Inc. You will be able to have fingerprints done anywhere in the United States. When making your appointment, be sure to have your credit card available for the applicable fees. The scheduling website works best with the Google Chrome browser. See the table below for further instructions.
|Step 1||Use the School of Optometry fingerprinting link to schedule your appointment.|
|Step 2||Enter all your personal information, following the prompts. Important: You must use the legal name that matches the name on your government ID when scheduling your appointment|
|Step 3 for CALIFORNIA Locations if you are doing the fingerprinting while in California||When in the state of California, you will be doing digital LIVESCAN for fingerprinting.Review all fingerprinting locations and make your appointment at a location that is most convenient for you and works best based on availability.|
|Step 3 for NON-CALIFORNIA Locations if you are doing the fingerprinting outside of the state of California|
If this applies, you will complete two (2) “hard cards” for your fingerprints with ink instead of having them submitted electronically.
These instructions are also outlined on the scheduling website as you make your appointment.
|When you are out of the state of California, you cannot do LIVESCAN fingerprinting. Instead, you must obtain and submit two hard-copy fingerprint cards done with ink.
Important: Be sure you DO NOT FOLD the hard cards across any fingerprints as it will interfere with processing. Your fingerprints will be submitted within 24 hours of receipt of the COMPLETE mail-in package.
|Step 4||Please complete ALL of the following three forms for your fingerprinting done at UCPD. If you do not provide UCPD with the forms, they will not know who to send the background check results to. Fax all forms as soon as you have completed your appointment ad fax to UCPD at (510) 643-4655.
1. Request for Live Scan Service. Print one copy and complete section 3 - see sample (Request for Live Scan Service SAMPLE). The ORI number is CA0019700 which goes on the top left of the form. Be sure to make/ask for a copy of the form once it has been processed by the agent (the agent may write down some transaction numbers). Even a photograph of the form is acceptable. In the case that you have to re-do the fingerprints, the agency may need to refer to the original LiveScan form.
2. Release and Disclosure Form (The witness can be anyone in Clinic Administration, UCPD, or if the former are not possible, anyone.)
3. Job Description for Optometric Interns.
- If you are attending Kaiser Daly City 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 Kaiser Daly City or AHS rotation. The background check must be completed by the earlier of the deadlines for AHS or Kaiser Daly City.) Please note that a background check done on mybackgroundcheck.com (acceptable for BOPC, Over 60s, or Travis AFB) WILL NOT be acceptable for Kaiser Daly City (must be done via Livescan).
- Attestation Letter – please provide documentation for all items on this letter as a pdf to Dr. Yu EXCEPT the first four items and the last three items. However, provide documentation of influenza vaccine if you are attending Kaiser Daly City during the months of October to March. Please ask Dr. Yu to complete and sign the form on your behalf after she has reviewed your documents.
Documentation Submit to and Date
- Due six weeks prior to start date.
- Send to:
- Stacey Liu, TPMG Nursing Educator, Kaiser Permanente South San Francisco, 1200 El Camino Real, South San Francisco, CA 94080, Office (650) 742-2095, Email: Stacey.A.Liu@kp.org
- After receiving your documents and reviewing for health clearance, Ms. Liu will set up an appointment with you to conduct a student orientation which includes reviewing a series of slides, signing mandatory HR attestations, and completion of a post-test with a score of at least 80%. The onboarding takes about two hours.
- Students are subject to the Berkeley Optometry Absence policy.