Required Immunisation applicable for student intake 2012 and 2013

Similar documents
OCCUPATIONAL HEALTH PROTOCOL

OCCUPATIONAL HEALTH PROTOCOL

Student Immunisation Record Faculty of Medicine. Section 1: Information. Notes

SAMPLE OF PRE-COURSE OCCUPATIONAL HEALTH QUESTIONNAIRE 2017

NOSM Learner Immunization Form

Health Card #: Expiry date: Province: Address (during academic program): Apt. #: City: Province: Country: Postal/Zip Code: Address: Apt.

Nursing and Midwifery students only. Section 1: Information

Children s Speech and Language Therapy Referral Form We see children up to their 18 th birthday

IMMUNIZATION REQUIREMENTS FORM


How to obtain vaccination records

Vaccine Trials Inquiry

FACULTY OF MEDICINE AND HEALTH SCIENCES SAFETY GUIDELINES FOR CLINICAL EDUCATION IN THE COMMUNITY

HUMBER COLLEGE & UNIVERSITY OF GUELPH-HUMBER

Immunization Policy & Forms. 33 Prospect Hill Road Cromwell, Connecticut / Tel. (860) Fax: (860) /

Immunisation Requirements and Mandatory Health Screenings

PRE-CLINICAL HEALTH REQUIREMENTS (PCHR) DUQUESNE UNIVERSITY SCHOOL OF PHARMACY

SUMMER HEALTH PROFESSIONS EDUCATION PROGRAM FOR ACCEPTED STUDENTS

HUMBER COLLEGE & UNIVERSITY OF GUELPH-HUMBER

Following this letter are health forms for parents or legal guardians to complete and sign. Please note that:

BLOOD-BORNE PATHOGENS EXPOSURE PROTOCOL ON-CAMPUS LABORATORY EXPERIENCES STUDENT PROCEDURES

Adult Education. If you have any questions, please contact the Student Health Services office at (914) , extension 2243.

HSS APPLICATION. Henley High School. Athlete Preparation Program

Bloodborne Pathogens Exposure Procedure

Last Name First Name MI SS# DOB. Address. City State Zip. Best Phone# (home/ work/ cell) Alternate # (home/ work/ cell)

PLEASE COMPLETE ALL RELEVANT SECTIONS OF THIS FORM

PRE-CLINICAL HEALTH REQUIREMENTS (PCHR) DUQUESNE UNIVERSITY SCHOOL OF PHARMACY

Clinical Preparedness Permit (Revised June 2018)

PRE-CLINICAL HEALTH REQUIREMENTS (PCHR) RANGOS SCHOOL OF HEALTH SCIENCES

PREREQUISITES FOR NON-MEDICAL STUDENT PLACEMENT

Vulnerable Sector Police

Vulnerable Sector Police

APPLICATION Athlete Preparation Program Term 1, 2019

CONTINUING CARE ADMINISTRATIVE MANUAL POLICY

MANITOULIN-SUDBURY DSB

Feidhmeannacht na Seirbhíse Sláinte

Policy S- 15 FLORIDA STATE UNIVERSITY COLLEGE OF NURSING BLOODBORNE PATHOGEN EXPOSURE CONTROL PLAN FOR NURSING STUDENTS

PRE-CLINICAL HEALTH REQUIREMENTS (PCHR)-Freshman,Transfer, 2nd Degree Nursing

Faith Academy Admission Form

Junior Volunteer Application

Patient Name Date of Birth / / Today s Date / /

Blood and Body Fluid Exposure

4. ADD/ADHD Medical Documentation Athlete is responsible for reading, completing, and providing required documentation.

DEPARTMENT OF GENITO-URINARY MEDICINE HEPATITIS B

Examples COMPLETED. Immunization Forms

Wisconsin Indianhead Technical College Allied Health and Nursing Divisions Health Form

Dear Student, Welcome to the University of Chicago!

Employment Application

Dental Senior House Officer

HOFSTRA UNIVERSITY DEPARTMENT OF PHYSICIAN ASSISTANT STUDIES

NEW INDIAN MODEL SCHOOL, DUBAI TEL

Center for Family Health Policy

IMMUNIZATION AND MEDICAL HISTORY FORM

STUDENT EXPOSURE TO BLOOD OR OTHER POTENTIALLY INFECTIOUS MATERIALS

Vassar College 124 Raymond Avenue Box 17 Poughkeepsie New York Please contact us at for any questions/concerns.

People s Panel today. You can use your views and experiences to help us help other young people.

Schools. Kindergarten

UNSCHEDULED VACCINATION OF CHILDREN AND YOUNG PEOPLE WHO HAVE OUTSTANDING ROUTINE IMMUNISATIONS. Service Specification

THE KEATS GROUP PRACTICE REGISTRATION FORM PLEASE COMPLETE IN BLOCK CAPITALS PERSONAL BACKGROUND INFORMATION

2017 BEING RU-FIT (First Year International Transition) Peer Mentor Position Description

2018 Bereavement Program Information

Bloodbourne Pathogens (BBP) Occupational Post-Exposure Chemophrophylaxis

Dental Hygiene Program Information Session. Conway Grand Strand Georgetown

Personal Information Name Campus Housing Resident Commuter Student ID Number Date of Birth Sex

MUSC Occupational Bloodborne Pathogen Protocol Off Campus Procedure Packet. Instructions for Employees/Students:

P L E A S E N O T E - There will be a charge for each person, even if your travel has been discussed previously with your own GP.

Phlebotomy Training Pre-Admission Application

Gait Analysis Client Intake Form

HOWARD UNIVERSITY STUDENT HEALTH CENTER. Checklist of Immunizations/TB tests/medical History/Physical Exam

2. Receive the Guidelines for the Allergist letter which is to be given to the prescribing allergist physician.

Healthcare Requirements for Health Science Students To Be Completed by your Primary Healthcare Provider

SHETLAND NHS BOARD NEWS RELEASE

Office Hours Our office hours are Monday through Friday 7:30 am to 5:30pm. Our office is closed on all major Holidays.

FORMS 1) PAR Q & YOU:

New Student Health Form

Immunisation Declaration Form - Version 2

Brook Green Centre for Learning. Policy and Guidance for Supporting Pupils with Medical Needs

(b) Repealed by Session Laws , s. 10, effective October 1, 2002.

2017 Bereavement Program Information

August 16, Prepared by Jeannette Russell

Holter monitor ECG. Patient instructions and diary. Collection centre Phone number

The Australian Immunisation Register. Presented by Tracie Hibbard and Lauren Patron

Student and Learner Placement Service Immunization & Infectious Diseases Screening

2019 Jr. Adventure Camp and Jr. Mustangs Camp Registration Form

DENTAL CLAIM FORM. Dental Discretionary Cover is provided via Incolink s Discretionary Fund and is governed by the Discretionary Guidelines

Holter monitor ECG (AR4 Plus) Patient instructions and diary

Dear Parent or Guardian,

ADVANCED LEARNING SCHOLARSHIP. Including the. JOHN and BETTY ROSE SCHOLARSHIP APPLICATION. All applications to be posted to:

Becoming a Peer-to-Peer Mentor

Surgical Technology Program Check List

Autism Advisor Program NSW

COMMON ERRORS ON IMMUNIZATION FORMS

MEMBERSHIP APPLICATION INSTRUCTIONS

Hospital-based Massage Training Program Admissions Check List

SUBJECT: Management of Human Body Fluids/Waste (Bloodborne Pathogens)

Birth Date Age Social Security # Marital Status (circle) Have you had chiropractic care in the past? Yes No If yes, how long ago?

SHENANDOAH UNIVERSITY HEALTH FORM

Transcription:

Required Immunisation applicable for student intake 2012 and 2013 Please note that as a Health and Safety pre-requisite only students who are certified to be immune from Hepatitis B can be allowed for clinical attachments at Mater Dei Hospital. Accepted first year students should have completed a full course of Hepatitis B vaccination and submitted their relative lab report of their Seroconversion Titre by 30 th June 2015. Students who took the 3 doses of Hepatitis B vaccine in the past need to follow the procedure marked A, as a Seroconversion Titre might be enough, depending on the result. Other students who did not take the 3 doses of Hepatitis B vaccine need to follow the procedure marked B and then follow the procedure marked A. What is a SeroConversation Titre? http://www.cdc.gov/hepatitis/hbv/hbvfaq.htm Procedure A: Local Students who took the 3 doses of Hepatitis B vaccine in the past need to follow this procedure: 1. Students should go to the area Health Centre of their locality from Monday to Friday from 0800 to 1700hrs or on Saturday from 0800 to 1300hrs. They should see the doctor, make a formal request and an appointment for the Seroconversion titre. 2. Those students who have not yet reached their 18 th birthday need to produce a letter of consent for Hepatitis B antibody level testing signed by the parent or guardian. The full name of the parent or guardian must be printed below the signature on the letter of consent. 3. Students should take with them the following documents to the Health Centre: a. the National Identity Card; b. the Immunization Record c. the Letter of Acceptance sent by the Registrar s Office of the University of Malta; and d. Annex 1 duly filled in. 4. It is very important that students adhere to the appointment given. 5. The Health Centre Staff will guide students as to when results should be collected from the respective Health Centre. Procedure B: Local Students who did not take the 3 doses of Hepatitis B vaccine in the past need to follow this procedure: 1. Students should go to the National Immunisation Services Floriana from Monday to Friday from 0800 to 1330hrs. 2. Those students who have not yet reached their majority age of 18 need to produce a letter of consent for Hepatitis B vaccination signed by a parent or guardian. The full name of the parent or guardian must be printed below the signature on the letter of consent. 3. Students should take with them the following documents to the National Immunisation Services, Floriana: 1

a. The National Identity Card; b. the Immunization Record; c. the Letter of Acceptance sent by the Registrar s Office of the University of Malta; and d. Annex 2 duly filled in. 4. The Immunisation Staff will evaluate the immunization status and advice will be given on pending vaccines. Hepatitis B vaccine will be administered to those who require it. Post-vaccination seroconversion titre should be done 6-8 weeks after the last dose of the Hepatitis B vaccination course. For the post-vaccination seroconversion titre students need to follow Procedure A. Titre results of all local and international should be submitted to the Faculty Officer on Campus, Department of Pharmacy to be assessed by the Occupational Health Unit. All students (local and international) who have a low antibody titre even after taking the 3 Hepatitis B vaccinations (doses) and a booster dose are required to fill in the Consent Form in Annex 3 in order to get authorization for clinical placements at any teaching hospital. 2

ANNEX 1 Hepatitis B Antibodies Applicants who have taken the three doses of Hepatitis B Immunisations are required to fill in the form below and present it to the respective Health Centre of their locality from Monday to Friday from 0800 hrs to 1700 hrs or Saturday from 0800 to 1300hrs. It is important that you take with you your immunization record, your national identity card and the University Library identity card. Surname: Name: I.D.Number: Address: Town: Post Code: Mobile Number: Tel. Number: Date of Birth: Signature: Date: 3

ANNEX 2 Applicants who have not taken any Hepatitis B Immunisations are required to fill in the form below and present it to the National Immunisation Services (NIS), Floriana Health Centre from Monday to Friday from 08:00 hrs to 13:30 hrs. It is important that you take with you your immunization record, your national identity card and the University Library identity card Surname: Name: I.D.Number: Address: Town: Post Code: Mobile Number: Tel. Number: Date of Birth: Signature: Date: 4

ANNEX 3 CONSENT FORM I, the undersigned, understand and agree that since, following three doses of a Hepatitis B vaccine my titre is not yet greater than 10IU/ml, I am allowed to do all clinical attachments however I may not: perform any interventions that involve the use of sharps on patients; go to the operating theatres and participate as an assistant in any operation. I bind myself to report any exposure to blood or body fluids (including needle stick injuries) to the Occupational Health or Infection Control Departments where I will be attached. I also understand and agree that Infection Control may be carrying out further tests in this regard and that a final strategy shall be communicated in due course. Signature Name (IN BLOCK LETTERS) Identification Number Mobile Number Approved by Faculty Board 16 th December 2014 5