Pocatello, Idaho - PEDS 664
Getting Ready for your Pocatello Peds Rotation
The Pediatric WWAMI Medical Student Program will contact you via email approximately 5-6 weeks prior to the start of your rotation. This email will request that you provide the following information:
Your first, middle and last name are required in order for you to begin your rotation.
Please complete this form and e-mail it to email@example.com
This form is due 5 weeks prior to the start of your rotation and must have your signature on it.
You may send this form by e-mail, fax or a scanned copy to:
WWAMI Program Operations Administrator
Fax: 208-334-2344 (ATTN: Adriana Olivas)
Forms for Pocatello Site
All forms are due 3 weeks prior to the start of your rotation.
Please send all forms to:
WWAMI Program Assistant
Fax: 208-239-3434 (ATTN: Heather Gunter)
- PMC S.T.E.P. Program Requirements and Application Form
- PMC Orientation & Post-Test - Complete and return only the answer sheet with your name, date and signature
- PMC Verification Form/Health Screening Form
- The student must provide documentation of:
- TB skin test within the last 11 months or if positive documentation of negative chest X-ray within the last 11 months.
- Immunity to Rubella by 2MMR’s, history of disease or positive titer
- Immunity to Rubeola by 2 MMR’s, history of disease or born prior to 1957, positive titer
- Hepatitis B Vaccine in progress, completed series or signed declination form
- Immunity to Varicella (Chicken Pox) by history of disease, positive titer, or 2 doses of varicella vaccine
- PMC I.T. Access Form
- PMC Confidentiality Agreement
- WWAMI Pediatric Rotation Housing Agreement for Pocatello
Medical Student Coordinator
Pediatric WWAMI Medical Student Office
A-5950, 4800 Sand Point Way NE
Seattle, WA 98105
Phone: (206) 987-2063