HEALTH CERTIFICATE

FOR HEALTH & SOCIAL CARE EXCHANGE STUDENTS IN PRACTIAL TRAINING

To be providedas a scan (pdf) during the application to MoveON or afterwards to .
Must be filled in and duly signed by ahealth care professionalin the student’s home country before the exchange!

Personal Information
Name of student (forename and surname)
Home country of student
Phone number of student (international format) / E-mail address of student
Date of birth of student (DD/MM/YYYY)
DD/MM/YYYY
Vaccination Information
Types / Date obtained (DD/MM/YYYY) / Optional/Additional information
dtap
(tetanus-diphteria-pertussis) / DD/MM/YYYY / Pertussis (whooping cough) valid for five years
Polio / DD/MM/YYYY / For students whose home country is within risk area.Valid for five years.
MMR
(measles-mumps-rubella) / I DD/MM/YYYY
II DD/MM/YYYY / or gone through all three illnesses
measles
mumps
rubella
Influenza
(during influenza period) / DD/MM/YYYY / valid for one year
Hepatitis-B (Engerix-B)
or Combination vaccine
Hepatitis A+B (Twinrix) / I DD/MM/YYYY
II DD/MM/YYYY
III DD/MM/YYYY
I DD/MM/YYYY
II DD/MM/YYYY
III DD/MM/YYYY
Varicella (chicken pox) / I DD/MM/YYYY
II DD/MM/YYYY / or gone through the illness
yes
Information on other samples and examinations (only if required)
F-BaktNhO / DD/MM/YYYY / Only required, if student will be working with food and has suspicious symptoms. No need for examining multiresistent bacteria!
Chest radiograph (X-ray) or pulmonary report, max 6 months old!The radiograph does not have to be provided – it is sufficient that the health care professional states the result in the respective text field
/ Date (DD/MM/YYYY):
DD/MM/YYYY
Result (to be stated): / Only required, if student
- was born in a country where the incidence of tuberculosis is very high (‘erittäin korkea’ in Finnish)
- has lived at least 12 months or has worked for at least 3 months in a country where the prevalence of tuberculosis is high (‘korkea’ in Finnish)
- has treated any infectious tuberculosis patient without a respirator or has been in close contact with a tuberculosis patient
Statmement of Health Care Professional
I hereby certify that the information provided about the student above is correct. In my opinion, this person has no problems that impact on his/her fitness to work/practice in a hospital or facility in health and social care.
Health care professional’s name in block letters, and signature
Place / Date
DD/MM/YYYY

Oulu UNIVERSITY OF APPLIED SCIENCES, INTERNATIONAL SERVICES:: oamk.fi
CITY OF Oulu, STUDENT HEALTH CARE::