Check list for Health and Insurance Requirements



Check list for Health and Insurance Requirements

Upload to Immunitrax per instruction sheet

Due dates for both Graduate and Undergraduate programs:

If your first clinical course is in fall: due August 1

If your first clinical course is in spring: due December 15

If your first clinical course is in summer: due April 1

Medical:

______ Physical Exam - student fills out Part I, Doctor or Nurse Practitioner should complete Parts II and III (gray four-page form)

______ Two-step Mantoux for TB (2 skin tests, one week apart) along with subsequent consecutive annual one-step mantoux (or documentation of 3 consecutive annual negative results; one must be the current year).

Positive TB Skin Reactors - Only if Mantoux is positive, negative chest xray or negative QuantiFERON Gold TB test, along with current symptom review.

______ Tetanus/Diphtheria/Pertussis TDaP (must be within the last ten years) Note: We do NOT accept Td Tetanus/diptheria

______ MMR #1 and #2 – OR - positive Rubeola and Rubella Titers

______ Hepatitis B series of 3 doses

______ Hepatitis B surface antibody qualitative titer

______ (Chicken Pox) Varicella vaccine (2 doses) - OR - Varicella Zoster Antibody IgG titer (If titer is negative, 2 doses Varicella vaccine must be administered.)

______ Flu shot or mist annually prior to October 1.

Insurance and Certification:

______ Copy of both sides of your CPR (or ACLS or PALS if required) card

______ Copy of both sides of your Health Insurance card

(If you carry WSU Student Health Insurance, you will need to submit a copy of your paid bill, which lists Student Health Insurance, each semester.)

RN License

______ Copy of verification of nursing license (not required for prelicensure students).

Background Checks

______ (Not required again if previously submitted for application to the program.) Clear FBI and Ohio BCI&I (or the State you reside) background checks. Fingerprinting is available at the Educational Resource Center in Allyn Hall. Send results directly to Zane Jacks 160 UH, Wright State University CoNH, 3640 Col. Glenn Hwy., Dayton, OH 45435.

***Please keep copies of everything you submit for your own records.***

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