Visiting Research Scholar/Scientist Application

If visiting scholar is a minor (under 18), parents/guardians must also submit a completed Supplemental Consent Form - https://www.chla.org/sites/default/files/atoms/files/CHLA-Research-Observer-Parent-Minor-Consent-01.pdf

Laboratory Safety Quiz

https://form.jotform.com/81894808707976

Mentor Approval Form

http://form.jotformpro.com/form/50967835297977

CHLA Intellectual Property Acknowledgement Form

Click to download: PDF

Please upload written documentation of the most current COVID-19 vaccination, including evidence of receiving either first dose of a one-dose vaccine regimen or second dose of a two-dose regimen*, plus, proof of booster(s) if applicable, or the Medical Exemption Form for the latest COVID-19 vaccination.

*Exemptions only for the current COVID-19 vaccination, not previous doses

Acknowledge the CHLA Confidential Policy

In order to protect the confidentiality of patient care and hospital matters, Children's Hospital Los Angeles considers all information regarding its patients, their families, hospital employees and hospital business as confidential. All board members, officers, employees, volunteers, residents/fellows, students, Medical Staff members or practitioners with temporary privileges are required to adhere to this policy and not release or disclose any information without appropriate written authorization. The hospital complies with all applicable federal (HIPAA) and state law regarding the release of protected health information.

This policy includes the confidentiality of medical staff records and procedures, all patient information, employee personnel files and information contained in the hospital computer systems. Board members, officers, employees, volunteers, residents/fellows, students, Medical Staff members or practitioners with temporary privileges are also asked to refrain from discussing any patient information or hospital business in public areas, including corridors, elevators, the cafeteria, hospital lobbies or waiting rooms.

ACKNOWLEDGEMENT:
I have read and agree to comply with the Children's Hospital Los Angeles, Confidentiality Policy. I understand that I am prohibited from divulging any information regarding patients, their families, employees or matters related to hospital business except as mandated by hospital policy and/or law.

Acknowledge the CHLA Policy & Procedure Addendum

• Code Blue - Medical Team Emergency
• Code Green - Hazardous Spill
• Code Yellow - Trauma Team Activation
• Code Red - Fire Emergency
• Code Orange - Disaster Plan Activation
• Code 10 - Missing Patient that is not suspected of being abducted
• Code 12 - Bomb Threat
• Code 13 - Community Disturbance / Code Orange Stand-By
• Code 99 - Hospital Lockdown/ Patient Abduction

Call Ext. 711 for Workplace Violence
Codes • Dr/Mr. Strong - Violent/Threatening Behavior Dr./Mr. Adam
Strong - Armed Individual

Identification Badges
Your ID badge must be worn on the upper body with the photo facing forward at all times when on the premises.  If you lose your ID, you must report it missing to Security (Ext. 12313) and the Parking Office (Ext. 12214)

Visitor Badges
All visitors (whether parents, guardians, families, vendors, etc.) must have a visible Visitor Badge on their person. Visitor badges are as follows:
• Yellow Badge -inpatient care areas
• Orange Badge -outpatient clinics and labs
• Red Badge -Emergency Department
• Blue Badge - Other Business
• White Badge - limited access - 1st floor Anderson Building only

Wrong Badge or No Badge • All Medical Staff, House Staff, and pre- & postdoctoral fellows and employees are responsible for:
• Escorting visitors without badges to the Guest Services Desk at the main entrance, or calling Security
• Asking if you can assist a visitor with the wrong badge who is in the wrong area. Example: Visitor with a blue badge is seen in an inpatient care area

I understand no grade or certificate of completion will be issued from CHLA for this experience (such grade or certificate of completion may, however, be issued from my school)

In addition to a general online laboratory safety training I will receive before I obtain my badge, I will ask my Supervising Principal Investigator to train me in the proper laboratory safety protocols specific to his/her lab and my project before I begin in the lab

I understand and agree that I, the Supervising Principal Investigator, and/or Children's Hospital Los Angeles may terminate my appointment at any time and for any reason prior to the scheduled conclusion of the appointment by providing written or oral notice to the other parties