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Graduate Clinical Requirements: Evergreen Hospital & Medical Center

Deadline/Where to Return Paperwork

At least 2 weeks prior to your clinical rotation. Send paperwork directly to the site.

Paperwork to Complete

1. Evergeen HIPPA for Covered Entities

2. HIPPA Assessment

3. Nurse Practitioner Application -  Ky Pham in Academic Servies will sign off on the immunization attestation form for you to put in with the rest of your application. Please contact Ky Pham at for this portion of your application.

At least 2 weeks prior to your rotation, mail these to:

Lynnette Wahl, Administrative Coordinator - Education Department

425.899.2524 (p)  |  425.899.2459 (f) |

EvergreenHealth MS-106, 12040 NE 128th St., Kirkland, WA 98034

Contact the Site

Midwifery students Only:

Diane Kovar, CPMSM
Manager, Medical Staff Office
Phone: (425) 899-1891

Diane will help you schedule an appointment to arrange completion of the remainder of your paperwork. Bring the following with you:

  1. Driver's license or passport
  2. Social Security Card

For ARNP/CNS students:

Karla Bushmaker, RN, MN
Staff Development Specialist
Phone: (425) 899-2529

Additional Site Requirements

  • The seasonal influenza vaccination is required for all students coming to Evergreen for clinical experiences.