Download Training and Professional Requirements

Clinical Requirements Guide
Name:____________________________________________________ Date:___________________
College:______________________________ Program: ____________________________________
This Clinical Requirements Guide is meant to be used as an informational guide for students to
further understand the University of Washington and Community Partners agreed upon,
requirements before participating in any patient care or clinical experiences. Students, faculty,
staff, and community partner’s all have a shared responsibility to protect ourselves and our
patients by taking reasonable precautions. All requirements will be verified by a private vender,
Certified Background (www.certifiedbackground). Please use this guide to gather the required
documentation before logging on to your Certified Background account.
It is your professional responsibility to know and keep current with your immunizations and health
requirements. Failure to comply with these requirements will result in a hold on your registrations,
and may delay your graduation. If you have a circumstances that is outside of these guidelines,
please contact us at: [email protected] and include a brief explanation.
Immunization Requirements
HEPATITUS B
Hepatitis B is an infectious disease caused by the Hepatitis B virus (HPV) which can cause both
acute and chronic infections of the liver. Health care workers with a risk of exposure to body fluids
such as blood must be prove that they are effectively immunized by submitting a lab report
confirming positive antibodies (anti-HBs or HepB Sab) are present in the blood. To be vaccinated
sufficiently, UWB requires a 3 shot vaccination series (0, 1, 6 months), and then confirmation of
positive titer 6-8 weeks later. If the titer does not show sufficient immunization (negative titer),
you must repeat a 3 part vaccination series again (shots 4-6), followed by confirmation of
immunization by positive titer 6-8 weeks later. A booster vaccination is not equivalent to repeating
the vaccination series #4-6, and will not be accepted.

Immunity confirmed by positive titer (anti-HBs or HepB Sab) lab report Date: _________
OR

Vaccination #1 - 3
Dates: _____________, _____________, ______________
Immunity confirmed by positive titer lab report
Date: ____________
If negative titer after vaccination, then repeat vaccination series. Booster is not acceptable.

Vaccines #4 - 6
Dates: ____________, _____________, ______________
Immunity confirmed by positive titer lab report
Date: ____________
If you have a circumstances that is outside of these guidelines, please contact us at
[email protected] and include a brief explanation.
UW1-211 Box 358532 18115 Campus Way NE Bothell, WA 98011-8246
phone: 425.352.5376 fax: 425.352.3237 email: [email protected] website: www.uwb.edu/nhs
Revised June 9, 2015
MMR (Measles, Mumps, Rubella)
Measles, Mumps, and Rubella (MMR) are three separate highly contagious infectious diseases. The
MMR vaccine is a mixture of live attenuated viruses of these diseases, generally administered to
children around the age of one year, with a second dose before starting school (i.e. age 4 or 5).
UWB requires you provided proof of vaccination of 2 doses at appropriate intervals OR positive lab
reports showing positive antibody titer for all 3 diseases.
 Vaccination Dates: ____________, _____________
OR
 Immunity confirmed by positive titer lab reports:
o Measles Date: ____________
o Mumps Date: ____________
o Rubella Date: ____________
VARICELLA (Chicken Pox)
Varicella is a highly contagious disease caused by the initial infection with Varicella zoster virus
(VZV). The virus may be spread 1 to 2 days before a rash appears, and is easily spread through
coughs, sneezes, and contact with the blisters. The varicella vaccine is recommended, with a
second dose administered 5 years after initial immunization. If you have a history of Chicken pox,
you must verify you are sufficiently immunized (measured by positive titer). Student are required
to upload documentation of vaccinations or lab reports confirming positive titer.


Vaccination Dates: ____________, _____________
OR
Immunity confirmed by positive titer lab report Date: ____________
TETANUS, DIPHTHERIA & PERTUSSIS (Tdap)
TDap and Tdap are both combined vaccines against diphtheria, tetanus, and pertussis (whooping
cough), three highly contagious diseases. (Note that the names are easy to confuse. The difference
is in the dosage, with the upper case letters meaning higher quantity.) The usual course of
childhood immunization in the USA is five doses between 2 months and 15 years. For adults,
separate combination (booster) vaccines are used that adjust the relative concentrations of their
components. Students are required to submit documentation that they received a TDap booster
within the last 10 years. After 10, years you are only required to obtain a booster for tetanus and
diphtheria (Td).

Tdap vaccination

Td booster vaccination
Date: ____________
Date: ____________
Revised June 9, 2015
TUBERCULOSIS (TB)
Tuberculosis, TB (short for tubercle bacillus), is a widespread, and in many cases fatal, infectious
disease caused by various strains of mycobacteria, usually Mycobacterium tuberculosis. In many
parts of the world, newborns are vaccinated with the Bacillus Calmette–Guérin (BCG) vaccine. The
US however has never used mass immunization of BCG, relying instead on the detection and
treatment of TB. For UWB student, you must submit either a Tuberculing skin test (TST) or a
QuantiFERON-TB blood test (QFT) to assess if you have a latent tuberculosis infection.
TST: Two skin tests are required the first time you are screened for TB. Once the first skin test is
administered you must return within 48-72 hours, to have your skin reaction assessed. If the
first skin test is negative, then you will receive the second skin test within 1-3 week. If the first
skin test is positive, a chest x-ray is required and an annual symptom checker must be
completed within 12 months.
QFT: Single blood test that can be assessed after a single patient visit. If results are positive,
you must then complete a TB Questionnaire.
Note that because TST and QFT do not measure the same components of the immunologic
response, they are not interchangeable. If you have received the BCG vaccine, you must take the
QFT. If your test results show you are positive for latent TB infection, you must complete a chest Xray, submit an annual symptom check from your health care provider, and complete a TB health
questionnaire.
Submitted Once



Tuberculing skin testing (TST)
1) Skin test #1 Date:________ Result: Neg____Pos_____mm____
2) Skin test #1 Date:________ Result: Neg____Pos_____mm____
OR
QuantiFERON (QFT) Date:________ Result:___________
OR
If history of BCG vaccine must receive QFT. If result is negative requirement has been met.
If positive, must provide clear chest X-ray & TB questionnaire (administered within last 12
months)
Exam Date: ________ X-ray Date: _________
TUBERCULOSIS (TB) - Yearly
Annual TB testing is required for all healthcare professionals (either a TST or QFT). For TST this
typically requires a single test, however, if it has been more that 12 months (i.e. your TST has
lapsed) you will need to repeat the whole TST two step sequence again. Remember it is your
professional responsibility to know and keep current with your immunizations.
Revised June 9, 2015
Submitted Every Year
 Annual TST
Date:________ Result: Neg____Pos_____mm____
Date:________ Result: Neg____Pos_____mm____
Date:________ Result: Neg____Pos_____mm____
OR

Annual QuantiFERON (QFT)
Date:________ Result:___________
Date:________ Result:___________
Date:________ Result:___________

If previously documented positive TST result and clear chest x-ray. If positive, must provide
clear chest X-ray & TB questionnaire (administered within last 12 months)
Exam Date________ X-ray Date_________
INFLUENZA (flu shot)
Three types of influenza affect people. Symptoms can be mild to severe. Usually, the virus is spread
through the air from coughs or sneezes. Due to the high mutation rate of the virus, a particular
influenza vaccine usually confers protection for no more than a few years. Students are required to
be vaccinated during the current flu season, and upload documentation proving annual
vaccinations every 12 months thereafter.

Vaccination Dates: ____________, _____________, ____________, _____________
If your history with this or other diseases are outside of these guidelines, please contact us at
: [email protected] and include a brief explanation of your circumstances.
Training and Professional Requirements:
PROFESSIONAL RN LICENSE
All students will need to provide documentation of a current RN license from Washington State.
Typically students can access their RN license online and submit a screenshot of their license. The
screen shot must include expiration date. To access your RN license go to
https://fortress.wa.gov/doh/providercredentialsearch/SearchCriteria.aspx

WA State Nursing License Number: _________________________ &
Expiration Date: ___________
BACKGROUND CHECKS (including Disclosure Statement)
A National Criminal Background Check and Washington State Patrol Background Check (WATCH) is
required for all students. These checks will include all counties of residence, all Washington State
counties per RCW 43.43.830 and OIG and GSA screens. Excluded provider search on OIG
http://exclusions.oig.hhs.gov/. A Washington State Patrol Background Check (WATCH) will be
required. Students whose background check reports a criminal offense, may be required to submit
a letter of explanation to the School of Nursing and Health Studies to review.
Revised June 9, 2015

National Criminal Background Check including Excluded Provider Search on OIG and GSA
Date __________
AND

Washington State Patrol Check (WATCH) annually.
Dates ________,________,________,________,________,________
CPR (Cardiopulmonary resuscitation)
CPR an emergency procedure performed in an effort to manually preserve intact brain function
until further measures are taken to restore spontaneous blood circulation and breathing in a
person who is in cardiac arrest. Basic Life Support (BLS) training for healthcare providers, will teach
students the importance of early CPR and defibrillation, basic steps of performing CPR, relieving
choking, and using an AED; and the role of each link in the Chain of Survival. The American Heart
Association (AHA) has created a BLS training program that can be administered by a number of
independent contractors. Some courses allow students to first complete online lessons, and then
meet with an AHA instructor for skills practice and testing. Many independent trainers offer CPR
courses for other professionals. Because of the variability of training programs, it is very important
to note that only the below CPR certificate will be accepted. Students are required to submit a
scanned copy (front & back) of their CPR card.

American Heart Association BLS Healthcare Provider Certificate. Date __________
HIPPA Training
HIPAA stands for the Health Insurance Portability and Accountability Act of 1996, which governs
the privacy of an individual's medical records. Employees of businesses that may come into contact
with records covered by HIPAA are required to undergo training on how to handle those records,
and they can be held accountable for violations of the act. All students must complete the on-line
HIPPA Training program on Certified Background website.

HIPPA Training Date: _________
Social Networking Policy Guidelines
It is important for all students to maintain the privacy of an individual’s history, especially on social
networking sites. Because of this UWB School of Nursing & Health Studies has developed their own
policy guidelines. Students are required to review this policy, and upload a signed copy of the
agreement.

Signed form acknowledging you have read and understand the policy Date: _________
Blood Borne Pathogen Form
The UWB School of Nursing & Health Studies had developed a policy on infection control
procedures for health care providers infected with HBV/HIV/HCV and other blood borne
pathogens. This policy also explains the Universities and community partner’s procedures if a
student has experienced an injury or been exposed to Blood Borne Pathogens (BBP). Students are
required to review this policy, and upload a signed copy of the agreement.
 Signed form acknowledging you have read and understand the policy
Date: _________
Revised June 9, 2015