In order to honor the contractual agreements of Purdue University Northwest with the affiliating agencies utilized for clinical experiences, students must provide evidence of:
- immunity to certain diseases
- evidence of a criminal background check(s) yearly, urine drug screen(s) yearly, a medical examination
- proof of personal health insurance and professional liability insurance
- yearly TB testing
- annual influenza vaccination
- current healthcare provider CPR certification
- HIPAA and universal precautions training.
In addition, the student is responsible to read and sign the Communicable Disease Exposure Policy, Essential Abilities Skill Verification Form, Honor and Civility Code Affirmation and Acknowledgement of UG Program Policies.
Any student who does not maintain the on-going required clinical documents by the due date will not be eligible to attend practicum courses and may be administratively withdrawn from the practicum course and/or any co-requisites.
|Hepatitis B Titer||
|Hepatitis B Refusal Form||This form is ONLY for students who have healthcare provider verification of being non-responsive to the Hepatitis B vaccine: Refusal of Hepatitis B for non-responders form|
|Influenza||By October 15th of each year a student MUST EITHER:
|Physical Examination||Submit your physical exam form completed and signed by a healthcare provider
|Urine Drug Screen||Go to Castle Branch.
|Criminal Background Check||Go to Castle Branch.
|Go to Castle Branch.
|OSHA/Universal Standard Precautions Requirement
|Go to Castle Branch.
|Medical Document Manager||Go to Castle Branch.
Information regarding your Medical Document Manager package will be sent to you via email. For more information, contact the Undergraduate Secretary.
|CPR Certification||Certification must be American Heart Association: Healthcare Provider Course.
American Red Cross is NOT acceptable.
|Proof of Health Insurance||All students must submit proof of health insurance in order to be eligible to attend clinical experiences. Please scan and upload the front of your Health Insurance Card
|Proof of Liability||Professional liability insurance is required to participate in clinical agency experiences. Liability insurance coverage is paid annually through fees attached to courses.|
|Communicable Disease Exposure Form||Download, print & complete the Communicable Disease Exposure Policy form and upload to this requirement.|
|Essential Abilities Skill Verification Form||Download, print & complete the Essential Abilities Skill Verification Form and upload to this requirement.|
|Honor and Civility Form||Download, print & complete the Honor and Civility Code Affirmation and upload to this requirement.|
|Acknowledgement of Undergraduate Program Policies||Download, print & complete the UG Handbook Acknowledgement form and upload to this requirement.|
All practice requirements based on The Centers for Disease Control and Prevention 2011 Report on Immunization of Health Care Personnel: Recommendations of the Advisory Committee on Immunization Practices (ACIP).