PROGRAM COORDINATORS for College / Residency / Advanced Practice Providers

STUDENTS
RESIDENTS / ADVANCED PRACTICE PROVIDERS

PRECLINICAL

STEP 1:  Complete the clinical/residency placement request process.

  1. Determine if a current contract/educational agreement with the health care organization exists. Please check with your school/residency program reps to confirm your school/residency program has a current agreement with the health care organization.
    • If yes, move to step B.
    • If no, contact healthcare student placement coordinator. This may take several months, so please reach out early.
  2. Complete the clinical / residency placement request form (Reviewed 5/14/2026). This Excel form has two sheets: 1) Preceptor Requests, 2) Groups with Instructor Requests. For preceptorships, requests should be submitted 10-12 weeks before the clinical start date. If you haven’t heard back in a reasonable amount of time, please contact the facility representative directly.
  3. Email the completed request form to the clinical/rotation agency contact.
  4. The healthcare organization will notify you of acceptance or denial. If approved, continue to Step 2.

STEP 2:  Complete the clinical/residency program placement process (after you receive approval).

Complete and submit the affiliation verification (Updated 5/14/2026) form to the clinical agency contact. Form is to be submitted on or by the clinical/residency program start date.

If required for placement, follow the appropriate process for computer training below.

Emplify Health (Bellin Health) – Epic
Epic & Pyxis Access Requests (Updated 2/26/2026 )
Email Epic access request to isaccess@emplifyhealth.org 
Pyxis and glucose monitor requests also need to be requested at the same time and are included with the Epic email.
Pyxis: Pyxis.Pharmacy@emplifyhealth.org 
Glucose Monitor: Mindy.Mayo@emplifyhealth.org
Bellin Health Epic Site-Specific Resource (Updated 07/30/2024 )

HSHS – Epic
Epic & Pyxis Access Requests – HSHS and Prevea(Updated 5/28/2025)
Epic access requests can be sent to Epic Access, Identity and Access Management – HSHS-Identity_and_Access_Mgmt@hshs.org
HSHS Gaining Student Epic Access Updated 11/22/2024
HSHS Epic Site-specific Resource (12/15/2025)
HSHS Epic Student Instructor Co-sign Handout7/31/2024
HSHS Epic Student Nurse Clinical Instructor Outline7/31/2024

Advocate Aurora Medical Centers – Epic For all NON nursing student placements at Advocate Aurora – All students receive access to our Learning Management System “Workday.” Access will need to be entered by an Aurora employee. Please complete the Epic & Pyxis Access Requests form and submit to unit leader.

Once access is granted, the student will need to complete the annual regulatory learning for the year they are at Advocate Aurora.  Students should screen shot their completed transcript and send it to their instructor for proof of completion.  This process will replace having the students view the onboarding modules from the GGBHA.  The affiliation verification and confidentiality forms have been updated to reflect these changes. 

***Epic access will be granted on a case-by-case basis. ***
Advocate Aurora Epic Site-Specific Resource Updated 7/01/2026

STEP 3: Students complete orientation modules.

Prior to working at a clinical site, the following orientation modules must be completed annually by students/residents/advanced practice providers/faculty. After completing all modules, and you understand the information presented, sign and submit the Confidentiality Agreement and Acknowledgment form to your school or faculty member. The school will retain the signed/dated forms. Do not submit this form to the health care facility.

ORIENTATION MODULES:

VIDEO: UNDERSTANDING HIPAA – YOU NEED TO KNOW THE BOUNDARIES

FORMS

PRECLINICAL FORMS
Affiliation Verification Reviewed 5/14/2026
Background Approval Policy Reviewed 5/14/2026
Criminal Background Check Process Reviewed 5/14/2026
Clinical / Residency Placement Request Forms Reviewed 5/14/2026
Sheet 1:  Preceptor Requests
Sheet 2:  Groups with Instructors Requests
Confidentiality Agreement and Acknowledgment of Orientation Modules – Reviewed 5/14/2026
Hepatitis B Declination Reviewed 5/14/2026 – This form does not apply for Advocate Aurora.
Immunization & Health Requirements – Reviewed 5/14/2026
New Instructor or New to Site Preclinical Checklist Reviewed 5/14/2026
DURING CLINICAL FORMS
Onsite Student / Advanced Practice Provide Resident Orientation Checklist Updated 5/14/2026

Student Assignments
Bellin College – Updated 5/14/2026
Lakeland University – Updated 5/14/2026
NWTC – Updated 5/14/2026
UW – Green Bay – Updated 5/14/2026

PRECEPTOR INFORMATION
RN Preceptor Handbook Updated 6/26/2026
Preceptor Agreement Reviewed 6/26/2026
Preceptor Evaluation of the Precepted Clinical Experience Reviewed 6/26/2026

POST CLINICAL

Advocate Aurora Health Care
Nursing students will complete the evaluation in myClinicalExchange.
Nursing Instructors: Evaluation

Emplify Health (Bellin Health) and other Healthcare Agencies
Students are to complete this form and return it to their college instructor.  Faculty should submit the completed ‘Student Evaluation of the Clinical Experience (Group or Precepted)’ forms to the healthcare facility’s clinical site coordinator no later than TWO WEEKS after completion of the clinical. (Resident coordinators see ‘Residents’ webpage for ‘Evaluation of Rotation Site’ form to be completed by residents.)
Student Evaluation of the Clinical Experience (Group or Precepted) Reviewed 5/14/2026

HSHS
Below are HSHS QR codes for student (blue) and faculty (green) post clinical evaluations