Dear student,

STUDENT MEDICAL ELECTIVE PLACEMENT – BENDIGO HEALTH

Thank you for your inquiry regarding a medical elective placement. Bendigo Health is one of the largest regional hospitals in the state of Victoria and provides services in emergency, surgical, maternity, women’s health, medical imaging, pathology, rehabilitation, community services, residential aged care, psychiatric care, community dental, hospice, palliative care, cardiology, cancer and renal services.

There are several requirements and forms that need to be completed before a placement can be offered within Bendigo Health:

  1. ‘Medical Elective Placement Application form’ – to be completed by both student (Part A) and Dean or designate of your University (Part B);
  1. National police/criminal history check from your country of residence for the past 10 years;
  1. Working with children check from your country of residence for the past 10 years;
  1. Copy of recent academic transcript;
  1. Copy of Medical Indemnity Insurance stating student name, date of birth, student number, placement dates and noting Bendigo Health Care Group;
  1. Vaccination and immunisation records including written proof of immunisations for TB, Rubella and Hepatitis B.

Please note, The Medical and Protection Indemnity Society (MIPS) indemnifies elective students for free in Australia. Please follow the link below and complete the form. You will need to provide proof of MIPS registration and acceptance before starting at Bendigo Health.

Costs

There are two payments required for a medical elective placement at Bendigo Health:

  1. An InternationalBank Cheque/Draftmade payable to ‘Bendigo Health – CHERC’ or credit card payment of $AUD200 must be included with your application form for administration fees. Please note this is non-refundable.
  1. Once a placement is offered to you, we will send you a ‘Medical Elective Acceptance of Offer’letter which is to be signed and returned to us with anInternational Bank Cheque/Draft or credit card payment of $AUD800 for the placement. This payment is also non-refundable.

There are no further charges for the placement, however you will need to organise your own accommodation. Bendigo Tourism has many accommodation options and can be contacted on the following web page:

Please note that we will do our best to find a placement for you but we cannot guarantee that we willbe successful. I look forward to hearing from you.

Yours sincerely,

Jodie Williams

Jodie Williams

Clinical Placement Co-ordinator

Clinical Deanery/Collaborative Health Education and Research Centre

Bendigo Health

BENDIGO HEALTH - MEDICAL ELECTIVE PLACEMENT

APPLICATION FORM

PART A: STUDENT

STUDENT DETAILS
Student name
Student address
Home phone (include international code) / Mobile (include international code)
Email / DOB
TERTIARY DETAILS
University/institution name
Address
Course name
Current year of course
Year of course during placement
University contact in faculty of medicine or equivalent / Name:
Phone:
Email:
Clinical medical experience you will have completed prior to the proposed elective
ELECTIVE PLACEMENT DETAILS
Discipline in which clinical placement is preferred /
  1. ______
  1. ______
3. ______
Dates (up to eight weeks) /
  1. From ______To ______No weeks ___
  1. From ______To ______No weeks ___

Checklist:

National Police/Criminal History Check from your country

of residence in the past 10 years

Working with Children Check from your country of

residence in the past 10 years

Copy of recent academic transcript

Copy of Medical Indemnity Insurance stating

student name, date of birth, student number,

placement dates and noting Bendigo Health

Vaccination and immunisation records

International Bank Draft for $AU200

madepayable to: Bendigo Health CHERC or credit

card payment (credit card payment form attached)

English language examination form (if relevant)

I certify that the information I have provided on this application form is complete and accurate to the best of my knowledge. I understand that misrepresentation of information on this application form will be deemed as sufficient grounds by Bendigo Health to withdraw its offer of placement.

______

STUDENT SIGNATUREDATE

PART B: UNIVERSITY DEAN OR DESIGNATE

Student name: ______

INDEMNITY
The above mentioned student is currently registered in his/her ______year of a ______year program of studies towards a Bachelor of Medicine Degree (or equivalent with the aim of becoming a registered medical practitioner in your country).
The ______(name of University) acknowledges that it accepts liability for personal injury or damage to property caused by ______(Student’s name), in connection with the placement of ______(Student’s Name) except to the extent that negligence on the part of Bendigo Health Care Group caused or contributed to the injury or damage.
Student’s progress in the course so far: Satisfactory Unsatisfactory
Students knowledge of English: Spoken slight/good/excellent
Written slight/good/excellent
English Language Exam Yes No
If yes, please provide exam results
Dean/designate signature: ______
Name:______
Title:______
Name of medical school: ______
Address of medical school: ______
______
______
Email: ______
University seal/stamp:

Please submit this form to:

Clinical placement co-ordinator

Clinical Deanery/CHERC

Bendigo Health

P.O. Box 126

Bendigo, Victoria, 3555

Australia

Phone: (61) 3 5454-6394

Fax: (61) 3 5454-6420

(if faxing this application, please forward original copies via air mail)

Payment details

(Please select one method of payment)

International Bank Draft/Cheque $AUD200.00

Credit Card

VisaMastercard

Card number:

Card expiry date:Total amount $AUD200.00

Card holders name: ______

Card holder’s signature: ______

Please return your payment to:

Bendigo Health

P.O. Box 126

Bendigo, Victoria, 3552

Australia

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