Tan Chingfen Graduate School of Nursing Health Clearance Checklist

The checklist below is to be used as a guide for submitting supporting official immunization and lab documentation to complete the health clearance requirements.  Copies of all official lab reports are required. Please review the checklist carefully and allow enough time, as it can take up to 2 months to complete.  All requirements must be met prior to your start date to be medically cleared.  Please upload all official documentation to the Peoplesoft Portal.  Any medical clearance questions are to be asked through the Student Health section of the Peoplesoft portal.  Once all requirements have been met your status will be approved.  Student health clearance documentation will be held in a secure electronic medical record at UMASS Memorial Health Care (UMMHC) in Epic. 

MMR Requirement (2 options)

 ____ Documentation of 2 valid doses of MMR vaccine (first dose given on or after 1 year old)

                                                      OR

 ____ Copy of lab documentation of positive measles, mumps and rubella IGG titers

Tdap

____ Documentation of a Tdap vaccine on or after age 11 is required

____ A Td or Tdap booster is required if it has been greater than 8 years since your last dose

Varicella

____ Documentation of two doses of Varicella vaccine OR copy of lab report for positive Varicella IGG titer

HEPATITIS B

____ Documentation of ALL Hepatitis B Vaccinations received

                                                      AND

____ Copy of lab report for Hepatitis B surface antibody titer (quantitative/numerical result)

____ Copy of lab report for Hepatitis B core antibody titer

____ Copy of lab report for Hepatitis B surface antigen titer 

If your Hepatitis B surface antibody titer is low/negative please complete the additional requirements:

____ Documentation of Hepatitis B booster vaccine (Heplisav-B vaccine (2-dose series) is preferred)

____ Copy of lab report for a repeat Hepatitis B surface antibody titer 4-6 weeks from booster dose. (If this result remains low you will need to receive the second booster dose and provide this documentation)

 

  IGRA/TST

____ Copy of lab report for a QuantiFERON Gold or Tspot after May 1^st of current year

____ If you do not have access to the lab test above you will need to provide documentation of two Tuberculin Skin Tests (TST).  Second test to be completed 1-3 weeks later.  One TST must be completed on or after May 1^st of the current year.

If you have a history of a positive TST or IGRA

____ Provide documentation of the positive result as well as any treatment received

____ Copy of a chest x-ray (written report) dated any time after the date of your positive result

____ If the date of your chest x-ray was not completed within the current year, complete the TB symptom review section of the TST form sign and date (Link to form is located above)

Physical

____ Please submit proof of wellness visit/ physical exam within the past 2 years.  This can be in the form of a visit summary indicating the date of the last physical exam. (Physical exam details are not required) 

Disclosure of PHI form

____ Sign and date agreement allowing Student Health to release records for compliance and experiences throughout your education at UMCMS (Link to form located above)

Respiratory Fitness Determination Form

____ Complete form and upload to portal (Link to form located above)

 

RECOMMENDED: Documentation of all covid vaccines /boosters received. Please include brand and dates.