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VA Casa Grande Community Based Outpatient Clinic (Casa Grande, AZ) – CASA GRANDE CBOC

Immunizations Required

  • Updated Tetanus and Diphtheria
  • HBV (Hepatitis B)
  • MMR
  • Current PPD/TB
  • Varicella
  • Tdap (Tetanus, Diptheria, Pertussis) – Get either a Td or Tdap booster shot every 10 years after first dose)
  • Influenza by November 30th of each year
  • Covid-19 Vaccine and booster
  • Student to keep originals of all documents and have them available in case they are requested.

Immunizations Records Submit to and Date:

  • If complete, acceptable if on file at Berkeley Optometry.

Documentation Required

WOC Application Package

  • VA Form 10-2850D Application for Health Professions Trainees
    1. Leave Section IV blank
    2. Applications without a valid Social Security Number (SSN) cannot be processed.
    3. Ensure that your name & SSN appear at the top of pages 2-4.
    4. Once completed, you must print out the entire document to sign in ink.
    5. Sign block 24A and date in block 24B on page 3.
    6. Don’t forget to fill out, sign & date page 4.
  • SF 61 Appointment Affidavit
    1. Type your name on the line following “I, ___”
    2. Print and sign just below item C.
    3. Do no fill in anything below your signature, below item C.
    4. Does not need to be notarized
  • OF 306 Declaration for Federal Employment
    1. Sign on line 17a as applicant (not appointee, line 17b)
    2. Please list your full legal name and any other names used, if you have no middle name please list “NMI” (no middle initial)
  • HR letter
    1. Full name, address at the top, sign and date bottom
    2. Circle veteran status at bottom of letter (above signature)
  • WOC Intake form
    1. Add your rotation dates to “dates of appointment” and “dates of training”
  • VA Rules of Behavior  
  • VA Random Drug Testing Notification
    1. For Training Program and Affiliate (keep the following): SAVAHCS Optometry Externship affiliated with Berkeley College of Optometry
  • Request for VA Identification Card
  • ADPAC survey/VA rotations questionnaire
    • Please list any VA rotations prior to or following your rotation at VA Tucson
  • After completion, please send back to Dr. Carla Engelke by March 1, 2023 either by mail or fax listed below:

Mail: Carla Engelke, OD
SAVAHCS, Eye Clinic
3601 S 6th Ave (11-112A)
Tucson, AZ 85723

Email: Carla.engelke@va.gov

FAX: (520) 629-4808

  • Updated contact info under security and access: Any questions or concerns: Computer/Portal/TMS please contact Wayne Anderson at hubert.anderson@va.gov, please contact our PIV office 520-792-1450 x1-4177
  • International Students and Social Security Numbers:
    • Health professions trainees (HPTs) training at VA medical centers receive temporary Federal appointments and personal identity verification credentials. To be properly vetted and eligible to participate in training, non‑US citizen HPTs who are temporarily in the United States must have:
    • A nonimmigrant F-1 or J-1 student classification; or, an I-20 (or DS-2019) certificate of eligibility; AND
    • A US Social Security Number
    • Unfortunately the use of a “pseudo-SSN” is prohibited in certain Federal systems. Your facility may have found work arounds, however use of a pseudo-SSN, or other 9-digit number, will not be permitted after May 1, 2018. Therefore, we are notifying the field in advance of this change in the onboarding process for non-US citizen trainees.
    • View the complete information from the Social Security Administration here.
For travel insurance coverage, please register all out-of-state travel at the UC Trips website to ensure coverage for each covered off-campus activity. You are covered from the time you start your travel to the rotation, through your rotation, and through your return trip.

Documentation Submit to and Date

  • ALL students are to complete and submit the WOC application package by March 1st in the spring of 3rd year of Optometry School by mail or fax to Carla Engelke, OD, SAVAHCS, Eye Clinic, 3601 S 6th Ave (11-112A), Tucson, AZ 85723
Requirement Deadline Return
☐ WOC Application Packet 3/1/2023 Return to Dr. Engelke by mail or fax at (520) 629-4808
☐ Fingerprinting locations No earlier than 120 days prior to 1st day of rotation and no later than 60 days prior to 1st day of rotation

 

 E-mail Dr. Engelke at Carla.Engelke@va.gov when completed with date and location
☐ TMS MTT certification 60 days prior to 1st day of rotation E-mail Dr. Engelke at Carla.Engelke@va.gov certificates when completed

 

Instructions Mandatory Training for VA Health Professions Trainees (HPT) – Here are the instructions for training. 

Security and Access

  • VA Identification Badge (PIV): You will need a PIV card for computer access and identity verification at every VA facility.
  • If you do not already have a PIV card and have completed your fingerprints, Dr. Rhodes will schedule an appointment to have your photo taken (Initial PIV registration) on your first day of orientation at SAVAHCS.
    • You will need to bring two forms of government ID’s not copies.
    • If you already have an active VA issued PIV card, you are not required to receive a new badge but will need access changed on card.  Please bring the card with you on your first day and we will facilitate this.
  • You will, however, need to make sure your fingerprints were taken no more than 120 days and no less than 60 days prior to the first day of your VA Casa Grande rotation (additional details below).
  • Fingerprinting: Due to a Federal mandate, students must be fingerprinted prior to their arrival at VA Casa Grande. If you will not be connected to a VA hospital prior to your rotation and/or have not had your fingerprints done at a VA facility 120 days prior to your rotation start date, you are required to complete them at least 60 days prior to your first day at SAVAHCS campus.
    • Fingerprinting instructions and locations are here.
    • Fingerprints must be taken at a VA location
    • Please email Dr. Engelke once completed including date and location that fingerprints were taken
  • If you are connected to a VA hospital prior to your rotation through Tucson, please e-mail Dr. Engelke when and where your fingerprints were taken.
  • You can be fingerprinted at VA San Francisco or VA Martinez.
    • You can be fingerprinted on a walk-in basis at VA San Francisco.
      • The SFVA PIV (Personal Identification Verification) Office is accepting “walk-in appointments” now.
      • The office hours are Mondays through Fridays from 8 a.m. – 11 a.m. and 1 p.m. – 3 p.m.
      • Enclosed is a blank Fingerprinting form. Please complete the form and include the appropriate SOI and SON numbers to identify the VA that you will be taking the fingerprints for. Most numbers can be found in the clinic manual under the requirements for that VA site.
      • Please bring 2 original and current forms of ID (one must be a Government-issued photo ID) and your completed Fingerprinting Form to your appointment.
      • The PIV Office is located in Building 4, 2nd Floor, Room 2A-103 (San Francisco VA Medical Center, 4150 Clement Street, San Francisco, CA 94121). Click for map of VA San Francisco PIV Office.
    • VA Martinez is another location that you can go to for fingerprinting.
      • VA Northern California Health Care System Martinez – PIV Office, 150 Muir Road, Bldg. 21 Rm 219, Martinez, CA 94553, (925) 372-2000, ext. 6755. The PIV office is located inside Bldg. 21 on the second floor in room 219.  Customer parking is located in the large gravel parking lot, across the street from Bldg 21. Click for map of VA Martinez PIV Office.
      • Open Monday through Friday 8:30 to 11:30 a.m 1-3 p.m. Closed for lunch between 12 and 1 p.m.
      • You can make an appointment by emailing v21macpivmartinez@va.gov. In the subject line, please indicate for “Fingerprinting.” In the message, please provide:
        • first name and last name
        • phone number
        • email address
        • three dates and times that work for you.
      • They will reply to confirm the date of your appointment.
      • You can also do walk-in fingerprinting on Wednesdays from 8:30 a.m to 11:30 a.m. to 1-3 p.m. Wait times vary.
      • What Documents to Bring to VA Martinez: 
        • Bring two pieces of identification with you.  1) one government identity source document ID with photo and your full legal name (including middle name); 2) one government identity source document ID (photo or non-photo) with your full legal name (including middle name). For example, you may use your state issued Driver’s license and a Social Security card, Passport, Voters Registration Card, Birth Certificate, School ID card or PIV card. Expired IDs are not acceptable.
    • Click here for Acceptable IDs.
    • The completed fingerprinting form. Please provide the SOI and SON (see below) of the VA that you need the fingerprints for so that they know where to send the results.
  • This must be done NO GREATER than 120 days before the start of your rotation and NO LATER than 60 days before the start of your rotation. If you are not local, follow the instructions for “out-of-state” courtesy fingerprinting on the student website and give the following information:
    • SAVAHCS Fingerprints
    • SOI# VAE9
    • SON# 1438
    • Organization: VHA
    • Employee type: Student/Trainee or Affiliate (if Student/Trainee option is not available)
  • Be sure to bring two picture IDs such as Driver’s License, Passport, School ID to the appointment.
  • Inform Dr. Engelke of your fingerprint date and location.
  • If you are not connected to a VA hospital and/or have not had your fingerprints done at a VA facility within the past 120 days of your rotation date, you are required to complete them 60 days prior to your first day at SAVAHCS campus and Dr. Rhodes will schedule your photo on your first day of orientation.  Please review Identity Documentation Criteria for badging.
  • If you are currently (within the 120 days) connected to a VA hospital, please indicate when and where your fingerprints were completed. (Please send an e-mail to TucsonPIVOFFICE@va.gov with information and to check if your fingerprints can be found in Tucson data base).
  • The following documents should also be reviewed:
  • Any questions or concerns: Computer/Portal/TMS please contact Wayne Anderson at hubert.anderson@va.gov. For PIV/Fingerprinting, please contact the PIV office 520-792-1450 x1-4177

Absence Policy

Personal leave is not granted during your fourth year with the exception of the following:

    • NBEO Boards:
      1. Leave requests should be submitted in writing (e-mail is acceptable) to Dr. Rhodes at least 30 days in advance of the days to be taken.
      2. Prefer day of test to be on a Monday or Friday or federal holiday.
      3. No requests for NBEO III leave will be granted for the first week of the rotation.
    • Residency Interviews
    • Academic Meetings: Students may be excused to attend a national optometric meeting with prior approval from Dr. Rhodes.
    • Federal Holidays: Dr. Rhodes will announce all observed holidays at the beginning of the quarter.
    • Professional Activities: At the discretion of Dr. Rhodes, activities that enhance professional development or are required for future residency/fellowship training or employment may also be considered.