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… ability to accommodate. Vaccination Recommendations/Requirements 1. Red Measles You require 2 doses of measles … current fit testing record along with your immunization requirements. • 3M model 1870/9210 • 3M model 8210 • 3M … where you are completing your residency. Immunization Requirements Vaccine/Titre Type Date yyyy/mm/dd Result Red …
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...
… ability to accommodate. Vaccination Recommendations/Requirements 1. Red Measles You require 2 doses of measles … current fit testing record along with your immunization requirements. • 3M model 1870/9210 • 3M model 8210 • 3M … where you are completing your residency. Immunization Requirements Vaccine/Titre Type Date yyyy/mm/dd Result Red …
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...
… ability to accommodate. Vaccination Recommendations/Requirements 1. Red Measles You require 2 doses of measles … current fit testing record along with your immunization requirements. • 3M model 1870/9210 • 3M model 8210 • 3M … where you are completing your residency. Immunization Requirements Vaccine/Titre Type Date yyyy/mm/dd Result Red …
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...
… ability to accommodate. Vaccination Recommendations/Requirements 1. Red Measles You require 2 doses of measles … current fit testing record along with your immunization requirements. • 3M model 1870/9210 • 3M model 8210 • 3M … where you are completing your residency. Immunization Requirements Vaccine/Titre Type Date yyyy/mm/dd Result Red …
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...
… of your PRIMARY affiliation. OHSS will contact you if any requirements are outstanding. Professional … at LHSC and St. Joseph’s to complete health screen requirements, and will reside at the Occupational Health … of your PRIMARY affiliation. OHSS will contact you if any requirements are outstanding. Professional …
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...
… Revised 20180423 Page 2 of 4 Vaccination Recommendations/Requirements 1. Red Measles You require 2 doses of measles … current fit testing record along with your immunization requirements. • 3M model 1870/9210 • 3M model 8210 • 3M … they are signed by a physician or nurse) Immunization Requirements Vaccine/Titre Type Date yyyy/mm/dd Result Red …
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/...
… Revised 20180423 Page 2 of 4 Vaccination Recommendations/Requirements 1. Red Measles You require 2 doses of measles … current fit testing record along with your immunization requirements. • 3M model 1870/9210 • 3M model 8210 • 3M … they are signed by a physician or nurse) Immunization Requirements Vaccine/Titre Type Date yyyy/mm/dd Result Red …
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/...
… Revised 20180423 Page 2 of 4 Vaccination Recommendations/Requirements 1. Red Measles You require 2 doses of measles … current fit testing record along with your immunization requirements. • 3M model 1870/9210 • 3M model 8210 • 3M … they are signed by a physician or nurse) Immunization Requirements Vaccine/Titre Type Date yyyy/mm/dd Result Red …
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/...
… Revised 20180423 Page 2 of 4 Vaccination Recommendations/Requirements 1. Red Measles You require 2 doses of measles … current fit testing record along with your immunization requirements. • 3M model 1870/9210 • 3M model 8210 • 3M … they are signed by a physician or nurse) Immunization Requirements Vaccine/Titre Type Date yyyy/mm/dd Result Red …
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/...
… Revised 20180423 Page 2 of 4 Vaccination Recommendations/Requirements 1. Red Measles You require 2 doses of measles … current fit testing record along with your immunization requirements. • 3M model 1870/9210 • 3M model 8210 • 3M … they are signed by a physician or nurse) Immunization Requirements Vaccine/Titre Type Date yyyy/mm/dd Result Red …
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/...
… Revised 20170206 Page 2 of 4 Vaccination Recommendations/Requirements 1. Red Measles You require 2 doses of measles … current fit testing record along with your immunization requirements. • 3M model 1870/9210 • 3M model 8210 • 3M … they are signed by a physician or nurse) Immunization Requirements Vaccine/Titre Type Date yyyy/mm/dd Result Red …
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/...
… Revised 20190227 Page 2 of 4 Vaccination Recommendations/Requirements 1. Red Measles You require 2 doses of measles … current fit testing record along with your immunization requirements. • 3M model 1870/9210 • 3M model 8210 • 3M … they are signed by a physician or nurse) Immunization Requirements Vaccine/Titre Type Date yyyy/mm/dd Result Red …
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/...
… Revised 20190322 Page 2 of 4 Vaccination Recommendations/Requirements 1. Red Measles You require 2 doses of measles … current fit testing record along with your immunization requirements. • 3M model 1870/9210 • 3M model 8210 • 3M … they are signed by a physician or nurse) Immunization Requirements Vaccine/Titre Type Date yyyy/mm/dd Result Red …
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/...
… Revised 20200624 Page 2 of 4 Vaccination Recommendations/Requirements 1. Red Measles You require 2 doses of measles … current fit testing record along with your immunization requirements. • 3M model 1870/9210 • 3M model 8210 • 3M … they are signed by a physician or nurse) Immunization Requirements Vaccine/Titre Type Date yyyy/mm/dd Result Red …
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/...
… Revised 20170206 Page 2 of 4 Vaccination Recommendations/Requirements 1. Red Measles You require 2 doses of measles … current fit testing record along with your immunization requirements. • 3M model 1870/9210 • 3M model 8210 • 3M … they are signed by a physician or nurse) Immunization Requirements Vaccine/Titre Type Date yyyy/mm/dd Result Red …
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/...
… days prior to your start date. OHSS will contact you if any requirements are outstanding. Professional … electives must provide proof of the following minimum requirements: 2 Varicella vaccinations or proof of immunity … information about TB Skin Test administration and reading requirements To be considered valid, a TB skin test must be …
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...
… days prior to your start date. OHSS will contact you if any requirements are outstanding. Professional … electives must provide proof of the following minimum requirements: 2 Varicella vaccinations or proof of immunity … information about TB Skin Test administration and reading requirements To be considered valid, a TB skin test must be …
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...
… Records 2. Q – Should I complete all my health screening requirements prior to the commencement of my primary … or start date? A – Yes. MUST: complete all health requirements prior to start date. • Clinical Fellows • … do I go if I require help in completing my health screen requirements? A – Depends on your position and start date. …
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...
… compliance status in relation to the mandatory immunization requirements as outlined in the Communicable Disease … compliance status in relation to the mandatory immunization requirements as outlined in the Communicable Disease …
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 ...
… of my compliance status in relation to the immunization requirements as outlined in the Communicable Disease … of my compliance status in relation to the immunization requirements as outlined in the Communicable Disease …
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 ...