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Health_Screen_Form_Electives_FINAL_20190227.pdf
… and Acellular Pertussis booster. If you are providing care to pregnant women and/or children, you should receive … is due. 7. Hepatitis B It is recommended that all health care workers receive a course of Hepatitis B vaccine. For … and Acellular Pertussis booster. If you are providing care to pregnant women and/or children, you should receive …
GUIDELINES FOR COMPLETION OF CITY-WIDE HEALTH SCREEN FOR VISITING ELECTIVES Revised 20190227 Page 1 of 4 (MUST Provide Proof) Past LHSC/St. Josephs Record: Yes No Anticipated Start Date of Clinical Placement (YYYY/MM/DD): Anticipated End Date of Clinical Placement (YYYY/MM/DD): First Name: Last Na...
Health_Screen_Form_Electives_FINAL_20190322.pdf
… and Acellular Pertussis booster. If you are providing care to pregnant women and/or children, you should receive … possible. 7. Hepatitis B It is recommended that all health care workers receive a course of Hepatitis B vaccine. For … and Acellular Pertussis booster. If you are providing care to pregnant women and/or children, you should receive …
GUIDELINES FOR COMPLETION OF CITY-WIDE HEALTH SCREEN FOR VISITING ELECTIVES Revised 20190322 Page 1 of 4 (MUST Provide Proof) Past LHSC/St. Josephs Record: Yes No Anticipated Start Date of Clinical Placement (YYYY/MM/DD): Anticipated End Date of Clinical Placement (YYYY/MM/DD): First Name: Last Na...
health_screen_form_electives_final_20190423_-_june_2020.pdf
… and Acellular Pertussis booster. If you are providing care to pregnant women and/or children, you should receive … possible. 7. Hepatitis B It is recommended that all health care workers receive a course of Hepatitis B vaccine. For … and Acellular Pertussis booster. If you are providing care to pregnant women and/or children, you should receive …
GUIDELINES FOR COMPLETION OF CITY-WIDE HEALTH SCREEN FOR VISITING ELECTIVES Revised 20190322 Page 1 of 4 (MUST Provide Proof) Past LHSC/St. Josephs Record: Yes No Anticipated Start Date of Clinical Placement (YYYY/MM/DD): Anticipated End Date of Clinical Placement (YYYY/MM/DD): First Name: Last Na...
Health_Screen_Form_Electives_FINAL_20190423.pdf
… and Acellular Pertussis booster. If you are providing care to pregnant women and/or children, you should receive … possible. 7. Hepatitis B It is recommended that all health care workers receive a course of Hepatitis B vaccine. For … and Acellular Pertussis booster. If you are providing care to pregnant women and/or children, you should receive …
GUIDELINES FOR COMPLETION OF CITY-WIDE HEALTH SCREEN FOR VISITING ELECTIVES Revised 20190322 Page 1 of 4 (MUST Provide Proof) Past LHSC/St. Josephs Record: Yes No Anticipated Start Date of Clinical Placement (YYYY/MM/DD): Anticipated End Date of Clinical Placement (YYYY/MM/DD): First Name: Last Na...
Health_Screen_Form_Electives_FINAL.pdf
… and Acellular Pertussis booster. If you are providing care to pregnant women and/or children, you should receive … is due. 7. Hepatitis B It is recommended that all health care workers receive a course of Hepatitis B vaccine. For … and Acellular Pertussis booster. If you are providing care to pregnant women and/or children, you should receive …
GUIDELINES FOR COMPLETION OF CITY-WIDE HEALTH SCREEN FOR VISITING ELECTIVES Revised 20160817 Page 1 of 4 (MUST Provide Proof) Past LHSC/St. Josephs Record: Yes No Anticipated Start Date of Clinical Placement (YYYY/MM/DD): Anticipated End Date of Clinical Placement (YYYY/MM/DD): First Name: Last Na...
health_screen_form_medical_affairs_city_wide_prof_res_fellows_2022-04-14_fillalbe.pdf
… may be obtained at your family physician/primary care office, local health unit, or community clinic. … Email: OHSS-medicalaffairs@lhsc.on.ca St. Joseph’s Health Care London Occupational Health and Safety Services P.O. Box … fellows. A 3rd dose/booster is required for those providing care at St Joseph’s Health Care London Mount Hope site, and …
1 CITY-WIDE HEALTH SCREEN FOR PROFESSIONAL STAFF/RESIDENTS/CLINICAL FELLOWS Anticipated Start Date of Clinical Placement (YYYY/MM/DD): Anticipated End Date of Clinical Placement (YYYY/MM/DD): First Name: Last Name: Gender: Date of Birth (YYYY/MM/DD): Family Physician: CPSO #: Phone: Email: Emergency...
Health_Screen_Form_Medical_FINAL 20180423_0.pdf
… and Acellular Pertussis booster. If you are providing care to pregnant women and/or children, you should receive … is due. 7. Hepatitis B It is recommended that all health care workers receive a course of Hepatitis B vaccine. For … Email: OHSS-medicalaffairs@lhsc.on.ca St. Joseph’s Health Care London St. Joseph’s Hospital Occupational Health and …
Revised 20170206 Page 1 of 4 GUIDELINES FOR COMPLETION OF CITY-WIDE HEALTH SCREEN FOR PROFESSIONAL STAFF/RESIDENTS/CLINICAL FELLOWS (MUST Provide Proof) Past LHSC/St. Josephs Record: Yes No Anticipated Start Date of Clinical Placement (YYYY/MM/DD): Anticipated End Date of Clinical Placement (YYYY/...
Health_Screen_Form_Medical_FINAL 20180423_1.pdf
… and Acellular Pertussis booster. If you are providing care to pregnant women and/or children, you should receive … is due. 7. Hepatitis B It is recommended that all health care workers receive a course of Hepatitis B vaccine. For … Email: OHSS-medicalaffairs@lhsc.on.ca St. Joseph’s Health Care London St. Joseph’s Hospital Occupational Health and …
Revised 20170206 Page 1 of 4 GUIDELINES FOR COMPLETION OF CITY-WIDE HEALTH SCREEN FOR PROFESSIONAL STAFF/RESIDENTS/CLINICAL FELLOWS (MUST Provide Proof) Past LHSC/St. Josephs Record: Yes No Anticipated Start Date of Clinical Placement (YYYY/MM/DD): Anticipated End Date of Clinical Placement (YYYY/...
Health_Screen_Form_Medical_FINAL 20180423_2.pdf
… and Acellular Pertussis booster. If you are providing care to pregnant women and/or children, you should receive … is due. 7. Hepatitis B It is recommended that all health care workers receive a course of Hepatitis B vaccine. For … Email: OHSS-medicalaffairs@lhsc.on.ca St. Joseph’s Health Care London St. Joseph’s Hospital Occupational Health and …
Revised 20170206 Page 1 of 4 GUIDELINES FOR COMPLETION OF CITY-WIDE HEALTH SCREEN FOR PROFESSIONAL STAFF/RESIDENTS/CLINICAL FELLOWS (MUST Provide Proof) Past LHSC/St. Josephs Record: Yes No Anticipated Start Date of Clinical Placement (YYYY/MM/DD): Anticipated End Date of Clinical Placement (YYYY/...
Health_Screen_Form_Medical_FINAL 20180423_3.pdf
… and Acellular Pertussis booster. If you are providing care to pregnant women and/or children, you should receive … is due. 7. Hepatitis B It is recommended that all health care workers receive a course of Hepatitis B vaccine. For … Email: OHSS-medicalaffairs@lhsc.on.ca St. Joseph’s Health Care London St. Joseph’s Hospital Occupational Health and …
Revised 20170206 Page 1 of 4 GUIDELINES FOR COMPLETION OF CITY-WIDE HEALTH SCREEN FOR PROFESSIONAL STAFF/RESIDENTS/CLINICAL FELLOWS (MUST Provide Proof) Past LHSC/St. Josephs Record: Yes No Anticipated Start Date of Clinical Placement (YYYY/MM/DD): Anticipated End Date of Clinical Placement (YYYY/...
Health_Screen_Form_Medical_FINAL 20180423.pdf
… and Acellular Pertussis booster. If you are providing care to pregnant women and/or children, you should receive … is due. 7. Hepatitis B It is recommended that all health care workers receive a course of Hepatitis B vaccine. For … Email: OHSS-medicalaffairs@lhsc.on.ca St. Joseph’s Health Care London St. Joseph’s Hospital Occupational Health and …
Revised 20170206 Page 1 of 4 GUIDELINES FOR COMPLETION OF CITY-WIDE HEALTH SCREEN FOR PROFESSIONAL STAFF/RESIDENTS/CLINICAL FELLOWS (MUST Provide Proof) Past LHSC/St. Josephs Record: Yes No Anticipated Start Date of Clinical Placement (YYYY/MM/DD): Anticipated End Date of Clinical Placement (YYYY/...
Health_Screen_Form_Medical_FINAL_0.pdf
… and Acellular Pertussis booster. If you are providing care to pregnant women and/or children, you should receive … is due. 7. Hepatitis B It is recommended that all health care workers receive a course of Hepatitis B vaccine. For … Email: OHSS-medicalaffairs@lhsc.on.ca St. Joseph’s Health Care London St. Joseph’s Hospital Occupational Health and …
Revised 20170206 Page 1 of 4 GUIDELINES FOR COMPLETION OF CITY-WIDE HEALTH SCREEN FOR PROFESSIONAL STAFF/RESIDENTS/CLINICAL FELLOWS (MUST Provide Proof) Past LHSC/St. Josephs Record: Yes No Anticipated Start Date of Clinical Placement (YYYY/MM/DD): Anticipated End Date of Clinical Placement (YYYY/...
Health_Screen_Form_Medical_FINAL_201902227.pdf
… and Acellular Pertussis booster. If you are providing care to pregnant women and/or children, you should receive … is due. 7. Hepatitis B It is recommended that all health care workers receive a course of Hepatitis B vaccine. For … Email: OHSS-medicalaffairs@lhsc.on.ca St. Joseph’s Health Care London Occupational Health and Safety Services P.O. Box …
Revised 20190227 Page 1 of 4 GUIDELINES FOR COMPLETION OF CITY-WIDE HEALTH SCREEN FOR PROFESSIONAL STAFF/RESIDENTS/CLINICAL FELLOWS (MUST Provide Proof) Past LHSC/St. Josephs Record: Yes No Anticipated Start Date of Clinical Placement (YYYY/MM/DD): Anticipated End Date of Clinical Placement (YYYY/...
Health_Screen_Form_Medical_FINAL_20190322.pdf
… and Acellular Pertussis booster. If you are providing care to pregnant women and/or children, you should receive … possible. 7. Hepatitis B It is recommended that all health care workers receive a course of Hepatitis B vaccine. For … Email: OHSS-medicalaffairs@lhsc.on.ca St. Joseph’s Health Care London Occupational Health and Safety Services P.O. Box …
Revised 20190322 Page 1 of 4 GUIDELINES FOR COMPLETION OF CITY-WIDE HEALTH SCREEN FOR PROFESSIONAL STAFF/RESIDENTS/CLINICAL FELLOWS (MUST Provide Proof) Past LHSC/St. Josephs Record: Yes No Anticipated Start Date of Clinical Placement (YYYY/MM/DD): Anticipated End Date of Clinical Placement (YYYY/...
Health_Screen_Form_Medical_FINAL_20190423.pdf
… and Acellular Pertussis booster. If you are providing care to pregnant women and/or children, you should receive … possible. 7. Hepatitis B It is recommended that all health care workers receive a course of Hepatitis B vaccine. For … Email: OHSS-medicalaffairs@lhsc.on.ca St. Joseph’s Health Care London Occupational Health and Safety Services P.O. Box …
Revised 20190423 Page 1 of 4 GUIDELINES FOR COMPLETION OF CITY-WIDE HEALTH SCREEN FOR PROFESSIONAL STAFF/RESIDENTS/CLINICAL FELLOWS (MUST Provide Proof) Past LHSC/St. Josephs Record: Yes No Anticipated Start Date of Clinical Placement (YYYY/MM/DD): Anticipated End Date of Clinical Placement (YYYY/...
Health_Screen_Form_Medical_FINAL.pdf
… and Acellular Pertussis booster. If you are providing care to pregnant women and/or children, you should receive … is due. 7. Hepatitis B It is recommended that all health care workers receive a course of Hepatitis B vaccine. For … Email: OHSS-medicalaffairs@lhsc.on.ca St. Joseph’s Health Care London St. Joseph’s Hospital Occupational Health and …
Revised 20170206 Page 1 of 4 GUIDELINES FOR COMPLETION OF CITY-WIDE HEALTH SCREEN FOR PROFESSIONAL STAFF/RESIDENTS/CLINICAL FELLOWS (MUST Provide Proof) Past LHSC/St. Josephs Record: Yes No Anticipated Start Date of Clinical Placement (YYYY/MM/DD): Anticipated End Date of Clinical Placement (YYYY/...
health_screen_medical_affairs_city_wide_professional_staff_2023-03-08.pdf
… First Name: Gender: Date of Birth (YYYY/MM/DD): Primary Care Provider/Physician: CPSO #: Phone: Email: Emergency … may be obtained at your family physician/primary care office, local health unit, or community clinic, or … Email: OHSS-medicalaffairs@lhsc.on.ca St. Joseph’s Health Care London Occupational Health and Safety Services P.O. Box …
1 CITY-WIDE HEALTH SCREEN FOR PROFESSIONAL STAFF/RESIDENTS/CLINICAL FELLOWS Anticipated Start Date of Clinical Placement (YYYY/MM/DD): Anticipated End Date of Clinical Placement (YYYY/MM/DD): Last Name: First Name: Gender: Date of Birth (YYYY/MM/DD): Primary Care Provider/Physician: CPSO #: Phone: E...
health_screen_medical_affairs_city_wide_professional_staff_2023-03-08.pdf
… First Name: Gender: Date of Birth (YYYY/MM/DD): Primary Care Provider/Physician: CPSO #: Phone: Email: Emergency … may be obtained at your family physician/primary care office, local health unit, or community clinic, or … Email: OHSS-medicalaffairs@lhsc.on.ca St. Joseph’s Health Care London Occupational Health and Safety Services P.O. Box …
1 CITY-WIDE HEALTH SCREEN FOR PROFESSIONAL STAFF/RESIDENTS/CLINICAL FELLOWS Anticipated Start Date of Clinical Placement (YYYY/MM/DD): Anticipated End Date of Clinical Placement (YYYY/MM/DD): Last Name: First Name: Gender: Date of Birth (YYYY/MM/DD): Primary Care Provider/Physician: CPSO #: Phone: E...
Health_Screen_QA_Completing_Screening_Process_FINAL_20190227.pdf
… 3 Email: ohss-medicalaffairs@lhsc.on.ca St. Joseph’s Healthcare • St. Joseph’s Clinical Fellows with a start date that … as mandated by the Ministry of Health and Long Term Care. LHSC Mailing Address St. Joseph’s Mailing Address … Rd. E., Room E1-402 London, ON N6A 5W9 St. Joseph’s Health Care London Occupational Health & Safety Services P.O. Box …
1 Occupational Health & Safety Services Questions and Answers - Health Screening Process 1. Q Where can I go to obtain documentation of my previous immunization, TB testing & serology? A Family doctor, medical school records, student health services, public health unit where you attended school, O...
health_screen_student_form_immunization_updated2016_aug23.pdf
… Institute Main Building  Parkwood Institute Mental Health Care  Southwest Centre Information obtained is strictly … to Occupational Health and Safety at St Joseph’s Health Care. I understand that my leader will be informed of my … Institute Main Building  Parkwood Institute Mental Health Care  Southwest Centre Information obtained is strictly …
S:\SJHC_IPAC_OHSS\OHSS\3. Operational\14. Health Reviews, Vol, & Transfers\3. Forms Health Review Form, August 2016 HEALTH REVIEW FORM Paid Staff Volunteer* Co-op Student* Student Sponsored Student (*refer to Volunteer Welcome document) St. Josephs Mt. Hope Parkwood Institute Main Building ...