Professional Letter



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Dear Agency Manager:

UCLA Health System policy requires that all individuals temporarily working in the UCLA Health System be oriented and educated on the regulatory requirements listed in this Temporary Staff packet. This includes all personnel working at Faculty Practice Group Physician Support Services office and Community Physician Network locations.

In addition to the required orientation and education documentation all individuals temporarily working in the UCLA Health System must have the Faculty Practice Group requires documented evidence of a background check and medical screening including a TB test and drug screen.

UCLA Health System Human Resources has created an online link for you to access the UCLA Health System Temporary Staff requirements and documents. Go the Faculty Practice Group specific site.

You can download all of the current forms and information from the following website:



We are asking that all temporary staff complete these items listed below at their respective agency before they begin their assignment. This documentation stays in the agency personnel file. Copies of all completed documentation should be forwarded to UCLA Healthcare Faculty Practice Group Human Resources, Attention Tammy Lang 5767 W Century Blvd Los Angeles, CA 90045 on or before the first day of the assignment. Periodic audits of these documents may be completed by UCLA Health System staff to assure appropriate compliance with these requirements.

1. Copy of completed Agency Application

2. Verification of (3) signed Abuse Reporting Statements (child, domestic, elder)

3. Verification of signed Confidentiality Agreement

4. World Class Practices: My Commitment to Care

5. C-ICARE Annual Training and Post Test

6. Orientation and Education Information and Post Test

7. Verification of completed HIPAA Training Module and Post Test

8. Evidence of Medical Clearance Criteria/TB Testing/ Drug Screening Completion

9. Evidence of Background Check completion

10. Verification of valid License/Certification/CPR Card (if applicable)

11. Age Specific Education Module and Post Test (if applicable)

12. Review of Nondiscrimination Policies

Temporary staff must also show original license / certification / CPR Card to assigned supervisor at the start of any assignment.

Please complete the Verification Checklist and return the form with a copy of all completed documents in the Temporary Staff packet as listed above. It is VERY important that we maintain complete files for all of our temporary staff. If you have any questions about the Temporary Staff process, please contact us at the phone number listed below. Thank you

Sincerely,

Andi Dow Ealey, Manager Tammy Lang, Administrative Assistant

310 301-5252 310 301-5200

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