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Palliative Care Focus:
Pre-Rotation Information: CONJ-667

• Pre-Rotation Info Orientation Site Contact Info

CONJ 667 Evergreen Hospice

1. Please complete the following informational questionnaire about your learning style and expectations. Save this document on your computer and email this to the various Coordinators before the beginning of the rotation.

2. The documents below must be completed and received by Evergreen Healthcare ONE MONTH prior to beginning your rotation. Mail or fax your paperwork to:

Bradley Pont, Credentialing Coordinator at (425) 899-1890 or
Evergreen Healthcare
Medical Staff Services
12040 NE 128th Street MS 50
Kirkland, WA 98034

If you have questions about these forms, please contact Mr. Pont at

  1. Medical Student Application Completion Checklist
  2. Clinical Rotation Application
  3. Immunization History Requirements
  4. Practitioner Behavioral Commitment
  5. Confidentiality & Security Agreement
  6. Medical Student Policy 121
  7. Review Complying with HIPAA course; submit assessment

3. Evergreen Healthcare also requires documented proof to verify that you have been vaccinated for the flu and a copy of your immunization record. If you do not have a current copy of your immunizations, you can email and request a copy of your immunizations to be emailed to you. It usually takes Hall Health about 3-5 days to process that request.


Info for Preceptors

Information for clinical preceptors on course goals and clerkship policies, as well as evaluation information and course forms.

Course Schedule

Clerkship Calendar

Chronic Care Didactic Schedules
(not including WWAMI, specific focus, or site meetings).

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