Escolar Documentos
Profissional Documentos
Cultura Documentos
4/2019
CLINICAL REQUIREMENTS SUBMISSION CHECKLIST
CPR Course Copy of signed CPR course completion card, front and back, listing expiration date.
Course must be American Heart Association (BLS – Health Care Provider).
Physical Examination Physical examination must be completed by primary care provider within 6 months of admission.
Signature of Health Care provider is required.
Hepatitis B* Hepatitis B titer indicating immunity
OR
+ *declination info Documented dates of 3 Hepatitis B vaccinations
OR
Formal declination and signed statement.
Mumps IGG titer indicating immunity (include lab work from Titer)
OR
Documented dates of 2 Mumps vaccinations. Doses must be 4 weeks apart.
Rubella IGG titer indicating immunity (include lab work from Titer)
OR
Documented dates of 2 Rubella vaccinations. Doses must be 4 weeks apart.
Rubeola IGG titer indicating immunity (include lab work from Titer)
OR
Documented dates of 2 Rubeola vaccinations. Doses must be 4 weeks apart.
TdaP Documentation of Tdap injection. (Expires after 10 years.)
TB (PPD) Date and results of the 2-step PPD (If PPD expires during school year, you are responsible for sending updated test
prior to expiration)
OR
Negative chest x-ray (done within the last five years and completed Health Screening Questionnaire for History of
Positive TB test.) PPD must be within 12 months of each clinical nursing course.
OR
The QuantiFERON-TB gold blood or the T-spot test is an acceptable alternative to the PPD.PPD and blood tests must
be within 12 months of each clinical nursing course.
4/2019
Varicella IGG titer indicating immunity (include lab work from Titer)
OR
Documented dates of 2 vaccinations. Doses must be 4 weeks apart. (Having had the disease is not proof enough.)
Seasonal Flu Vaccine Seasonal flu vaccination, one dose annually (Wait until September/October to get this)
+*declination info Formal declination and signed statement. (complete declination and later submit receipt for immunization)
Urine Drug Screen Follow directions provided for obtaining urine drug screen through Castlebranch.
www.Castlebranch.com
Employment Follow directions provided for obtaining through Castlebranch. For students who are age 21 and over.
Verification
www.Castlebranch.com
4/2019