Tan Chingfen Graduate School of Nursing Health Clearance Checklist
Please download the attached Health Clearance Form below as a guide to requirements for your program. Please do not delay as some follow up labs can take approximately 1- 2 months to complete.
Please note: Student Health does not complete incoming student health requirements.
All documentation submitted must include last name, first name and date of birth to be accepted. Student Health will update the electronic checklist as documentation is reviewed and provide feedback when indicated. If you have a question, you may post and submit it though the portal explanation section.
Forms required for your program can be found under the forms section of the website.
It is recommended students visit the Student Health website ahead of your start date to review available healthcare options. Student healthcare is community based due to UMASS Chan’s location and partnerships in the area www.umassmed.edu/studenthealth
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 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
____ 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
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 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. ( Note TST symptom review form link is above and should only be filled out if you have had a POSITIVE TST or IGRA)
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 your most recent COVID vaccine including brand.