Tan Chingfen Graduate School of Nursing Health Clearance Checklist
Please use this checklist as a guide to complete the health clearance requirements. Review carefully and allow enough time to schedule the necessary lab tests, follow-up labs, in addition to your physical exam and vaccine requirements. All requirements must be met prior to your start date to be medically cleared. Please upload and submit official documentation, lab reports and vaccines to the Peoplesoft portal for review. You may write a message to Student Health through the portal in the explanation section. Student Health will review the documents as they are received and communicate through the portal checklist and messaging. Documentation must be translated to English. Please remember that ALL health documents submitted must contain patient identifiers (first name, last name, and date of birth or they will not be accepted).
Once all health clearance items have been accepted your status will be “approved”. Students in “partially approved” status may start school but are responsible for completing the remainder ASAP or when due.
Please note: Student Health does not complete student pre-matriculation requirements. Student health clearance documents will be held in EPIC, a secure electronic medical record at UMASS Memorial Health Care (UMMHC).
MMR Requirement (2 options)
____ Documentation of two 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 9 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 (Please have your provider order all Hepatitis B titers together.)
____ Documentation of ALL Hepatitis B Vaccinations received
AND
____ Copy of lab report for Hepatitis B surface antibody titer
____ Copy of lab report for Hepatitis B core antibody titer
____ Copy of lab report for Hepatitis B surface antigen titer
*** Note if you already had a POSITIVE Hepatitis B Quantitative titer result in the past you are NOT required to have the additional core antibody OR surface antigen checked.
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 formula is preferred.)
____ Copy of lab report for a repeat Hepatitis B surface antibody titer 4 weeks from booster dose. (If this result remains low you will need to receive the second booster dose, repeat titer and and provide this documentation.)
IGRA/TST
____ Copy of lab report for a QuantiFERON Gold or T-spot after May 1st 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 1st 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.
(Link to form located above.)
Physical
____ Please submit proof of an annual 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). Please do not include extraneous lab tests, paperwork or other materials. A single page indicating the date the physical exam was completed is sufficient. Specialty exams, exams for episodic visits or employment exams are not accepted.
Disclosure of PHI form
____ Sign and date agreement allowing Student Health to release records for compliance and experiences throughout your education at UMass Chan. (Link to form located above.)
Respiratory Fitness Determination Form
____ Complete form and upload to portal (Link to form located above.)
RECOMMENDED: Documentation of your most recent COVID vaccine including the brand