Clinical Requirement Forms
Please download and read the following Requirements forms:
Flu Shot Update – Fall Semester 2012
All students are required to obtain the seasonal flu vaccine on an annual basis. Students who do not provide documentation of receiving a seasonal flu vaccine will be removed from clinical and withdrawn from the lecture portion of the course as well.
II. Health and Other Requirements
1. Physical Examination: All the following health requirements must be confirmed by a licensed health care provider. A physical examination by a licensed health care professional, using the Trinity Washington University Health Screening Forms. This form must be submitted to the Nursing Program Office in the healthcare provider’s sealed, return address envelope, with the provider’s signature across the seal of the envelope.The student must provide copies of all medical records to the nursing program for each of these requirements (copies of original immunization records, titer lab results, chest x-ray report, etc.)
The Trinity Health Forms can be downloaded from the Trinity website accessing the following link: Updated Health Screening Form. The physical exam must be completed annually while enrolled in the nursing program.
Physical Exam (PE): You must be medically cleared to attend clinical. This is an annual requirement. Students who fail to keep the PE current will be unable to register for the next semester and/or risk being dropped from clinical courses. Only the complete Trinity Physical Exam form will be accepted.
2. TB Screening:
a. BCG: For those students with a history of bacille Calmette–Guérin (BCG) injection: you must provide documentation of testing with either IGRA (CDC recommendation) or PPD.
b. Annual PPD: negative PPD [TB skin test (TST)] done within the past year. This must be renewed every year.
c. Positive TB skin test:
- Stating “history of positive PPD” is insufficient. You must provide a copy of the original medical document containing the actual measurement reading.
- A positive PPD requires either a negative chest x-ray every 2 years or a negative serum TB antibody screen (IRGA). A positive chest x-ray or antibody screen requires documentation of follow-up with a licensed provider and medical treatment as indicated.
- Annual TB screening thereafter: Negative TB symptom questionnaire performed with a licensed health care provider. Any manifestations of disease will require a chest x-ray and follow-up with a licensed provider and medical treatment as indicated.
Immunization record must be completed by a licensed health care professional, using the Trinity Washington University Health Screening Form. This form must be submitted to the Nursing Program Office in the provider’s sealed, return address envelope, with the provider’s signature across the seal of the envelope.
- MMR (Measles, mumps, rubella): 2 doses of MMR vaccine or positive antibody titer for each disease. History of the disease is not adequate.
- Tetanus/Diphtheria, Pertussis (TDaP): Vaccination with TD (tetanus/diphtheria) must be within 10 years. Vaccination with Pertussis must be no earlier than 2005. Pertussis vaccination may be given separately (alone) if dosing with the TDaP is too early for TD booster.
- Varicella (Chicken Pox): 2 injections of the Varicella vaccine or a positive Varicella antibody titer level. History of the disease is not adequate.
- Polio: Completed polio vaccination series or positive polio antibody titer. Documentation of 3 doses of either OPV or IPV is required for a completed series. Four doses are required for a completed series if the OPV and IPV are given as a combined treatment.
- Hepatitis B: immunizations with 3 injections of the Hepatitis B vaccine or positive Hepatitis B antibody titer level and date drawn. You must have the initiated the series and provide documentation of the first injection to attend clinical. The series should be completed within 6 months of the initial injection. Students who fail to continue the series and/or complete the series will be unable to register for the next semester and/or risk being dropped from clinical courses.
- Seasonal Influenza vaccine (flu): This is an annual requirement. You will not be allowed in the clinical setting if your flu vaccine is expired. Students who fail to keep their flu vaccine current will be unable to register for the next semester and/or risk being dropped from clinical courses. Be aware that flu vaccine production may be limited. Also be aware that composition of the flu vaccine may change each year. Therefore, hospitals may require immunization with the newest flu vaccine lot, requiring up-dating the flu vaccine before your last immunization has expired.
4. Proof of personal health insurance coverage: students are required to maintain current major medical health insurance major health insurance coverage for the duration of enrollment in the nursing program.
5. CPR Healthcare Provider: Only Healthcare Provider CPR (BCLS) from the American Heart Association will be accepted. CPR from sources which do not provide the hands-on skills check-off will not be accepted. You will not be allowed in the clinical setting if your CPR card is expired. Students who fail to provide a current CPR card will be unable to register for the next semester and/or risk being dropped from clinical courses.
In addition to the above requirements, the clinical agencies may have additional health or safety requirements which students are required to meet prior to receiving access to the clinical placement site. Changes may occur each semester in the Nursing Program’s clinical requirements, therefore students are expected to routinely check the nursing section of the Trinity website for programmatic updates.
NOTE: Students will not be allowed to participate in clinical experiences unless and until all of the above requirements have been completed and submitted as required.
1. Drug screen: Completed upon entrance into the nursing program. Be aware that all clinical agencies (hospitals, clinics, etc.) have the right to require an alcohol and/or drug screen on you at any time while you are in the clinical setting. Students will be required to take a drug test at their expense prior to the start of the clinical portion of the program. Students may be denied access to clinical placement sites by the agencies based on the results of their drug test.*
2. Criminal background check with fingerprinting: upon entrance into the nursing program. Trinity requires you to complete this background check through www.certifiedbackground.com. Please be aware that Trinity and the clinical agencies reserve the right to determine if it is appropriate for you to continue in clinical. Therefore, any serious findings on the background check may prevent a student from continuing in the nursing program. Any arrests occurring after acceptance and during enrollment must be immediately reported to the Associate Dean of the Nursing Program. Failure to promptly notify the Director may be grounds for dismissal from the program.
Students will be required to submit to a background check and fingerprinting at their own expense prior to the start of the clinical portion of the program. Students may be denied access to clinical placement sites by the agencies based on the results of their background check and fingerprinting.*
* Items #1 and #2 above (Drug Test Screening and The Criminal Background Check with Fingerprinting) are performed only through www.certifiedbackground.com; the code that should be entered at time of purchase is RI53all.
Uniform: Approved complete Trinity purple uniform with short white lab jacket with trinity patch and Trinity name pin. White leather shoes- to protect feet against injury and contamination. Trinity photo ID badge. Plain wrist watch with second hand. Stethoscope. Students are expected to follow the Nursing Student Handbook for attire and appearance. Failure to do so may result in dismissal from clinical and/or unsatisfactory in clinical.
1. Trinity Bookstore
2. Fenton’s Uniforms LLC
8726 Georgia Avenue
Silver Spring, MD 20910
Mon-Fri 9:30am-6:00pm and Sat 10:00am-4:00pm
For any questions, please call the Nursing Program Office at 202-884-9670 or e-mail at firstname.lastname@example.org.