San Juan Regional Medical Center

San Juan Regional Medical Center

Clinical Rotations
Welcome to the Rotations Application page for Medical Students and Advance Practive Providers.

Learners or their School's Clinical Advisors can complete this page. Before you start filling out this form, there are some things you should know.
- Please only submit one application per rotation request. It's crucial that we don't have duplicate information entered the system, and duplicate applications will be declined.
- Fields with a Red * are required fields. The system will only submit your application if all necessary fields are completed. Incomplete applications are not accepted.
- If you have a Preceptor please add their information.
- If you are having difficulty finding a preceptor, please indicate in the box at the bottom of the page. You can also contact the clinical coordinator, Desiree Kenneth, directly at clinicalrotations@sjrmc.net.
- This application is ONLY intended for MD, DO, PA, NP, CRNA, and CNM.
Please note, there has be an affiliation agreement with San Juan Regional Medical Center and YOUR university before clinical rotations are scheduled.
Current SJRMC EmployeeReturning Learner
Full Name*

First NameLast Name
Contact Email*
Phone Number*
Please enter a valid phone number.
Educational Institution *
Student Type*
Rotation Start Date*

MonthDayYear
Rotation End Date*

MonthDayYear
School Clinical Coordinator/Advisor Name*
Name and title
School Clinical Coordinator/Advisor Email*
School Clinical Coordinator/Advisor Phone Number*
Clinical Rotation Specialty*
Which specialty are you intending to rotate through?
Do you have a Preceptor? *
If yes, please include their name in the box to the right.
Preceptor Name
Full Name
Learner Level in Program
Only for MD/DO students
Student/Preceptor Agreement Form

Can be found under Finding a Preceptor on Clinical Rotations - San Juan Regional Medical Center
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NMDOH Background Check Completed*

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NMDOH Fingerprinting

You can complete at SJRMC Campus - COPY OF SSN IS REQUIRED.
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10-Panel Drug Screen*

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Health Screening and Immunizations*

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N95 Fit Test

If you had this completed please attach, otherwise a form will be sent to you.
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San Juan Regional Medical Center

Welcome to the Rotations Application page for Medical Students and Advance Practive Providers.

Learners or their School's Clinical Advisors can complete this page. Before you start filling out this form, there are some things you should know.