Student Clinical Check-In

Welcome to Erlanger’s student check system. It is important for the safety of the patients, visitors, and staff that an attendance is kept for all clinical partners. Please complete the follow attendance information. Thank you for helping make Erlanger a safe working environment. If you have any issues with this form or any problems with your clinical experience please contact Clinical@erlanger.org.

Date Date * / MM / DD YYYY
Time Time * : HH MM AM/PM
Name Name * First Last
Program and School: *
Role: *

Role: Student Instructor
Placement: *
Instructor's Name: *
Preceptor's Name: *
Leader's Name: *
Program: *
Describe "Other" Placement: *
Instructor's Contact:
Email *
Phone Phone * - ### - ### ####
Erlanger Campus *

Erlanger Campus Baroness Erlanger Hospital Erlanger East
Department Name: *
List "Other" Department Name: *
Please, click submit ONLY ONE TIME. Thank you!

Student Clinical Check-In

Student Clinical Check-In

Instructor's Contact: