Student Health Record Informational

STUDENT HEALTH RECORD INFORMATIONAL

CHECKLIST SHEET

*Actual form must be completed by your Health Care Practitioner

Please be advised that health records for all HealthScience Students must be complete before the start of the semester and they must be kept current. It is your responsibility to see that your health records are up to date at all times.

____Medical clearance by your health care practitioner that you are able to

fully participate in clinical activities

____ Color blindness testing

____Tdap (Tetanus, Diphtheria, Pertussis) vaccine. If your Td (tetanus/diphtheria) vaccine is older than 2 years, Tdap is required. Tdap is good for 10 years.

____Two step PPD (tuberculosis) to be followed by one PPD annually thereafter.

**** A two step PPD involves two PPD tests performed no less than 2 weeks and no more than 6 months apart.

____If the PPD is positive a chest x-ray must be performed and a Symptom

Assessment form must be completed annually thereafter.

____CPR card indicating expiration date

CPR CERTIFICATION BY THE AMERICAN HEART ASSOCIATION – HEALTH CARE PROVIDER LEVEL NO exceptions!

_____Flu vaccine annually

Titers – Lab reports MUST be attached to form

____Titer indicating immunity for Rubeola (Measles).

• If not immune, 1 booster is required, then a repeat titer

____Titer indicating immunity for Rubella (German Measles).

• If not immune, a booster is required, then a repeat titer

____Titer indicating immunity for Mumps.

• If not immune, a booster is required, then a repeat titer

____ Titer indicating immunity for Varicella (Chicken Pox).

• If not immune, 2 vaccines are required, then a repeat titer

____Titer indicating immunity for Hepatitis B.

• If not immune after initial series, 3 vaccines are required, then a repeat titer.

Please keep copies of all health records that are submitted.