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… St. Joseph’s Staff and affiliates require a 2-Step TB Skin test (TST). The 2-Step TB skin test is given 1- 52 weeks apart from the first single TST. A TB skin test may be given on the same day as a live vaccine, but … St. Joseph’s Staff and affiliates require a 2-Step TB Skin test (TST). The 2-Step TB skin test is given 1- 52 weeks …
HEALTH REVIEW FORM Volunteer Co-Op Student Post-Secondary Student Sponsored Student Proof of immunization is required and includes any of the following: Vaccination records from yellow immunization cards, immigration records, notes from a physicians office, copies of laboratory reports (titre le...
… immunizations or proof of immunity and TB testing should be submitted in English and in Pdf format. … vaccination and timing of other vaccinations and TB skin test: Other vaccinations should not be given within 14 days … administration of a COVID- 19 vaccine. If a TB skin test is required, it must be administered and read before …
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...
… immunizations or proof of immunity and TB testing should be submitted in English and in Pdf format. … (flu) Seasonal influenza vaccination, or completion of an attestation form is required. LHSC and SJHC offer onsite … All vaccinations, including the Tuberculosis (TB) Skin Test should not be given within 14 days prior to, or 28 days …
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 C...
… immunizations or proof of immunity and TB testing should be submitted in English and in Pdf format. … (flu) Seasonal influenza vaccination, or completion of an attestation form is required. LHSC and SJHC offer onsite … All vaccinations, including the Tuberculosis (TB) Skin Test should not be given within 14 days prior to, or 28 days …
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 C...
… immunizations or proof of immunity and TB testing should be submitted in English and in Pdf format. … vaccination and timing of other vaccinations and TB skin test: Other vaccinations should not be given within 14 days … administration of a COVID- 19 vaccine. If a TB skin test is required, it must be administered and read before …
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...
… immunizations or proof of immunity and TB testing may be obtained at your family physician/primary … administration of a COVID- 19 vaccine. If a TB skin test is required, it must be administered and read before … may take place at any time after all steps of TB skin testing have been completed. If a TB skin test must be …
1 CITY-WIDE HEALTH SCREEN FOR VISITING ELECTIVES 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 Contact Person: Contacts P...
… immunizations or proof of immunity and TB testing should be submitted in English and in Pdf format. … (flu) Seasonal influenza vaccination, or completion of an attestation form is required. LHSC and SJHC offer onsite … 3 TUBERCULOSIS (TB) SURVEILLANCE Tuberculosis (TB) Skin Test Proof of a baseline two-step TB skin test is required …
1 CITY-WIDE HEALTH SCREEN FOR VISITING ELECTIVES 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 Contact Person: Contacts P...
… immunizations or proof of immunity and TB testing should be submitted in English and in Pdf format. … (flu) Seasonal influenza vaccination, or completion of an attestation form is required. LHSC and SJHC offer onsite … 3 TUBERCULOSIS (TB) SURVEILLANCE Tuberculosis (TB) Skin Test Proof of a baseline two-step TB skin test is required …
1 CITY-WIDE HEALTH SCREEN FOR VISITING ELECTIVES 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 Contact Person: Contacts P...
… immunizations or proof of immunity and TB testing should be submitted in English and in Pdf format. … (flu) Seasonal influenza vaccination, or completion of an attestation form is required. LHSC and SJHC offer onsite … 3 TUBERCULOSIS (TB) SURVEILLANCE Tuberculosis (TB) Skin Test Proof of a baseline two-step TB skin test is required …
1 CITY-WIDE HEALTH SCREEN FOR VISITING ELECTIVES 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 Contact Person: Contacts P...
… immunizations or proof of immunity and TB testing should be submitted in English and in Pdf format. … (flu) Seasonal influenza vaccination, or completion of an attestation form is required. LHSC and SJHC offer onsite … 3 TUBERCULOSIS (TB) SURVEILLANCE Tuberculosis (TB) Skin Test Proof of a baseline two-step TB skin test is required …
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...
… immunizations or proof of immunity and TB testing should be submitted in English and in Pdf format. … (flu) Seasonal influenza vaccination, or completion of an attestation form is required. LHSC and SJHC offer onsite … 3 TUBERCULOSIS (TB) SURVEILLANCE Tuberculosis (TB) Skin Test Proof of a baseline two-step TB skin test is required …
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...
… immunizations or proof of immunity and TB testing should be submitted in English and in Pdf format. … (flu) Seasonal influenza vaccination, or completion of an attestation form is required. LHSC and SJHC offer onsite … 3 TUBERCULOSIS (TB) SURVEILLANCE Tuberculosis (TB) Skin Test Proof of a baseline two-step TB skin test is required …
1 CITY-WIDE HEALTH SCREEN FOR VISITING ELECTIVES 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 Contact Person: Contacts P...
… immunizations or proof of immunity and TB testing should be submitted in English and in Pdf format. … (flu) Seasonal influenza vaccination, or completion of an attestation form is required. LHSC and SJHC offer onsite … 3 TUBERCULOSIS (TB) SURVEILLANCE Tuberculosis (TB) Skin Test Proof of a baseline two-step TB skin test is required …
1 CITY-WIDE HEALTH SCREEN FOR VISITING ELECTIVES 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 Contact Person: Contacts P...
… immunizations or proof of immunity and TB testing should be submitted in English and in Pdf format. … (flu) Seasonal influenza vaccination, or completion of an attestation form is required. LHSC and SJHC offer onsite … 3 TUBERCULOSIS (TB) SURVEILLANCE Tuberculosis (TB) Skin Test Proof of a baseline two-step TB skin test is required …
1 CITY-WIDE HEALTH SCREEN FOR VISITING ELECTIVES 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 Contact Person: Contacts P...
… immunizations or proof of immunity and TB testing should be submitted in English and in Pdf format. … (flu) Seasonal influenza vaccination, or completion of an attestation form is required. LHSC and SJHC offer onsite … All vaccinations, including the Tuberculosis (TB) Skin Test should not be given within 14 days prior to, or 28 days …
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 C...
… start date. The required/recommended vaccinations and TB testing may be administered at your family physician’s … to send their completed form with proof of immunizations/testing to the Victoria Hospital Occupational Health, Room … to send their completed form with proof of immunizations/testing to the St. Joseph’s Hospital Occupational Health …
Revised 20160411 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/...
… start date. The required/recommended vaccinations and TB testing may be administered at your family physician’s … to send their completed forms with proof of immunizations/testing to Victoria Hospital Occupational Health Department … Surveillance and Isoniazid (INH) If your Tuberculin Skin Test (TST) status is unknown, or previously identified as …
GUIDELINES FOR COMPLETION OF CITY-WIDE HEALTH SCREEN FOR VISITING ELECTIVES Revised 20160108 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...
… immunizations or proof of immunity and TB testing should be submitted in English and in Pdf format. … (flu) Seasonal influenza vaccination, or completion of an attestation form is required. LHSC and SJHC offer onsite … 3 TUBERCULOSIS (TB) SURVEILLANCE Tuberculosis (TB) Skin Test Proof of a baseline two-step TB skin test is required …
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...
… immunizations or proof of immunity and TB testing should be submitted in English and in Pdf format. … (flu) Seasonal influenza vaccination, or completion of an attestation form is required. LHSC and SJHC offer onsite … 3 TUBERCULOSIS (TB) SURVEILLANCE Tuberculosis (TB) Skin Test Proof of a baseline two-step TB skin test is required …
1 CITY-WIDE HEALTH SCREEN FOR VISITING ELECTIVES 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 Contact Person: Contacts P...