Petaluma Health Center (Rohnert Park, CA) – PETALUMA
- Health Questionnaire
- Vaccination records. Please provide copies of vaccination and TB Testing records
- Tdap (within the past 10 years)
- Hep B (titer or vaccination record)
- TB/PPD Clearance (must be current in last 12 months). NOTE: You are required to have had a total of 2 PPD tests done within the last 12 months.
Immunizations Records Submit to and Date:
- Please submit your documents to Precilla San Ramon, Human Resources Program Specialist, 1179 N. McDowell Blvd., Petaluma, CA 94954, (707) 559-7617 ext. 1830, FAX (707) 664-5147 eight weeks before your start date. You may fax the documents (no cover sheet required) or scan and email them to her firstname.lastname@example.org.
- Government issued picture I.D. (e.g. Driver’s license, state ID, passport, etc.) – Please submit photocopy
- Current BLS/CPR Certification – Please submit photocopy
- Student HIPAA Business Associate Agreement
- Confidentiality Agreement
- Parking Pass Request Form
- Student Intern Data Sheet
Documentation Submit To and Date
- Please submit your documents to Debbie Williams, Credentilaing Specialist, 1179 N. McDowell Blvd., Petaluma, CA 94954, (707) 559-7529, FAX (707) 238-1426 eight weeks before your start date. You may fax the documents (no cover sheet required) or scan and email them to her.
- Project Manager Suzanne Cochrane will be in contact with you to cover any final details including on-site parking and building access. Suzanne can be reached at email@example.com or by phone at (707) 772-6332
- Students are subject to the Berkeley Optometry Absence policy.