1. Health Requirements
Department of Nursing

2. Health Requirements: Background
Mount St. Joseph University Department of Nursing has a contract with each healthcare facility where students attend clinical. The health requirements are determined by these contracts. We are required to send verification of compliance with these health requirements prior to the start of each clinical rotation.
As a professional nurse, you will be required to be compliant with vaccinations, TB screening and CPR certification for continued employment and clinical practice.
It is important to keep your own copy of all of your health requirements for future employment opportunities.
Note: Importance of keeping a copy of all health records for future employment opportunities.

3. Medical Forms are legal documents.
You may not edit or alter medical forms once they have been signed and dated by the health care provider.
Editing or altering Medical Forms is considered falsifying documentation.
Please ensure that your documentation is complete and accurate before you leave the health care provider’s office.
MSJ forms are available on the Nursing Hub under Health Requirement Forms tab.

4. Medical History / Validation of Physical Exam Form
Medical History/Validation of Physical Exam is valid for three years.
All areas of this form must be completely addressed or the form will not be accepted.
The Medical History/Validation of Physical Exam Form must be scanned, uploaded and entered in to E*Value prior to the deadline.
If your scanned documentation is illegible, you will be asked to resubmit your documentation via E*Value. You may also be asked to submit the original to the Clinical Coordinator, Seton W138.
If you use your mobile device, please use a “scanner app” instead of the digital camera on your phone. (“Genius Scan”, “TinyScan” and “CamScanner” are FREE and use your phone’s camera to scan your documents into a high-quality jpeg or pdf. )
For Incoming BSN sophmores, it is best to complete the physical exam between May15-August 1st time frame so that it does not expire before your graduation date.

5. Documentation Samples
Unacceptable:
Acceptable:

6. Medical History / Validation of Physical Exam Form
Insurance and Medical History problem areas:
Though you are required to submit a copy of your insurance card, the insurance information also needs to be filled out on this form.
In the medical history section, each condition needs to have a date or an “X” in the appropriate box. “N/A” or “none” is also acceptable. All areas need to be marked in some fashion
In the medical history section, each condition needs to have a date OR an “x” in the appropriate box. “N/A” or “None” or a line through the space is also acceptable. ALL areas need to be marked in some fashion.

7. Medical History / Validation of Physical Exam Form
Insurance & Medical History completely addressed:
Note that each box has an “N/A” or “None” or a line through the space.

8. Medical History / Validation of Physical Exam Form
Physician Release & signature incomplete:
Physician Release & signature complete:
Notice on the incomplete form, the Physician Release has not been checked nor is the form dated. If either of these pieces of information is missing, you will need to return to your health care provider.

9. Immunization Record: Reminders
All areas of this form must be completely addressed or the form will not be accepted. This form must be signed and dated by your healthcare provider.
You can expect 4 visits to your health care provider to get all necessary vaccinations and tests completed.
The Immunization Record must be scanned, uploaded and entered into E*Value prior to the deadline. No other immunization records are required.
The influenza vaccine is required of all students during the Fall semester.
Flu vaccine must be for the current season. A receipt is not valid proof of receiving the flu vaccine. (ie Walgreens receipt etc) There must be documentation that the flu shot was administered to you. Forms are available on the Nursing Hub if needed.

10. Documentation Samples
Unacceptable:
Acceptable:
Please upload a good quality scan of the immunization record.

11. Immunization Record: Measles and Mumps
Either two vaccine dates OR a serology date is considered proof of immunity
Incomplete information:
If you only have received 1 dose of the MMR vaccine in the past, you need to receive another dose now.
If you had a lab test/ serology to verify immunity to MMR, this form stull needs to be completed. Lab results are not required.
If you had a lab test/serology to verify immunity to MMR, this form still needs to be completed. Lab results are not required.
Complete information:

12. Immunization Record: Varicella (Chicken Pox)
Either a history of varicella disease, OR vaccine dates, OR positive serology considered proof of immunity
Incomplete information:
If you don’t know the exact date you had varicella/chicken pox, we need to have at least an approximate year on the form. OR
2. If you never had the chicken pox and received the VZV vaccine, you must have received 2 doses for this to be considered proof of immunity.
3. The date of the serology needs to be indicated on the form. Copies of lab reports are not required, however, if they are submitted with the form, they can be used to verify date and immunity status.
Complete information:

13. Immunization Record: Tdap
Tdap is not the same as Dtap
Tdap is not the same as TD
Since Tdap was not licensed until 2005, the record below is inaccurate:
If you had Dtap as a child, this does not protect you from Tetanus, diptheria and pertussis (whooping cough) as an adult. (Tdap is the adult version of the vaccine.)
If you have only received a TD vaccine, you will need to receive a Tdap vaccine now which include pertussis (whooping cough). If your record has a date prior to 2005, you did not receive the Tdap. You received TD.

14. Immunization Record: Hepatitis B
All 3 doses must be received in order to attend clinical
This vaccination series takes approximately 6 months to complete.
If you have received the entire series of 3 vaccines in the past, it does not need to be repeated.
Incomplete information:
The Hepatitis B series takes approximately 6 months to complete the series. If you will not have the Hepatitis B vaccine series (all three injections) completed by the deadline, please contact Prof. Turner Bicknell and Dr. Burns ASAP.
Complete information:

15. Immunization Record: TB screening
As a nursing student, a 2-step PPD skin test is required. If your 2-step PPD test was administered incorrectly, as below, you will need to repeat the entire 10-day process.
2-step PPD skin test administered incorrectly (2 errors):
The 2-step PPD is required upon entrance into the program. We follow the 4 visit protocol. If your 2-step test was given using a different protocol, you will need to repeat it now. Each subsequent year only the 1-step PPD is required. The entire process cannot exceed 21 days.
Additional forms are available on the Nursing Hub
Correct administration:

16. Immunization Record Signature and date incomplete:
Signature and date complete:
Your Healthcare Provider will need to sign/date pg.2 of the Immunization record. If the record is not signed and dated, you will need to go back to your Healthcare provider for a signature.

17. CPR: FAQ’s Q: What type of course do I need to take?
A: American Heart Association (BLS for health care providers / HeartCode BLS) or American Red Cross (CPR for professional rescuers) ONLY
When in doubt, make sure the course covers Adult, Child & Infant CPR and AED for Adult and Child
Courses offered by ASHI (American Safety and Health Institute) are not accepted by our clinical facilities
Q: I took CPR last year and the card doesn’t expire for 2 years. Do I need to re-certify?
A: Maybe.
For the MAGELIN Program, Your CPR certification must be valid at the beginning and for the duration of the program. If your CPR certification will expire prior to your graduation date, then you must renew now.
For BSN Program, Your CPR certification must be valid for the entire academic year. It is required that you renew your CPR certifications between May 15 and August 1st so that they remain valid for the entire academic year. If your CPR card will expire during the academic year, you will need to renew prior to the August 1st deadline.
Q: My card won’t be ready for a few weeks, can I submit a letter from the instructor or an online certificate?
A: Yes, BUT this does not substitute for the card. We will accept this so you can attend clinical, but the card (front and back) is still required. Please be sure to sign the back of your CPR card prior to uploading it to E*Value.
MSJ CPR Verification Form located on the Nursing Hub has an example of the information that is needed if a certificate is not immediately available.
Courses can be found online.
Must be taken w/in 12 mos. of admission.

18. CPR: Sample Card
A copy of the front and back of the CPR card must be scanned, uploaded and entered into E*Value prior to the deadline.
If your scanned documentation is illegible, you will be asked to re- submit via E*Value.
Expiration date may be valid for 2 years, but it must be current throughout the duration of the program. Be sure to sign your card.
For MAGELIN Students, make sure the expiration date of your card is after your graduation date . For BSN students, the expiration date must be valid for the entire academic year.

19. Health Insurance: Reminders
Students are required to submit proof of health insurance annually.
This will be done during the annual renewal period each year: May 15-August 1st.
A copy of the front and back of the insurance card must be scanned, uploaded and entered into E*Value prior to the deadline. Please be sure to include the plans effective and expiration dates.
If your scanned documentation is illegible, you will be asked to resubmit your documentation via E*Value. You may also be asked to provide the original to the Clinical Coordinator, Seton W138.
Per MAGELIN handbook: All health requirements must be current by the beginning and for the duration of the semester.
MSJ will no longer be offering health insurance starting 8/2015

20. Annual Renewals
All documentation needs to be uploaded and verified prior to the deadline to be considered compliant.
Academic consequences for non-compliance will be imposed at the discretion of the course leader.
The annual health requirement renewals include:
1-Step Tuberculosis Skin Test or Chest X-ray(if required)
Proof of Health Insurance
Seasonal Influenza Vaccine

21. Mount St. Joseph Student Wellness Center
The Wellness Center will administer 1-step and 2-step TB skin tests, the Hepatitis B vaccine, the Tdap vaccine and the Seasonal Influenza vaccine. They DO NOT administer MMR or Varicella vaccines.
Documentation for vaccines and skin tests received at the Wellness Center need to be uploaded into your E*Value profile. The Wellness Center or the Clinical Coordinators cannot upload your documentation.
Call the Wellness Center at for an appointment.
Visit the MyMount Website Health Services page for Wellness Center hours and pricing:

22. E*Value: Electronic Health Records Database
E*Value is a web-based program that Mount St. Joseph University uses to manage student health requirements.
Your initial E*Value login and password information will be ed to your MSJ student account. Instructions for use of E*Value will also be available on the Nursing Hub. If you do not receive your login/password within 2 months of your start date, please contact
All health requirements documentation must be submitted electronically to E*Value for verification by the clinical coordinator.
Please check your documentation in E*Value to see that it was scanned correctly and legible. Your scanned documentation must be uploaded as a jpeg or pdf.
If your documentation is not uploaded correctly or verified prior to your clinical rotation, you will not be able to attend.

23. Contact Information
Sandra Lott, Clinical Coordinator
Mount St. Joseph University
5701 Delhi Road | Cincinnati, OH
Phone: (513)
Fax: (513)
Office: Seton W138
Please make an appointment to meet with me if you need further assistance with the health requirements for nursing clinicals.
You are welcome to me if you would like to check on the status of your documentation and I will respond in a timely manner. If you have health requirements that are due on a Friday and you upload them after I have checked E*Value, you may need to wait for the following business day in order for the results can be verified. If you had a Monday clinical, you may be sent home. DO NOT wait for the deadline because there is often additional information/ documentation that may be needed.
You will need to keep copies of all your documentation for your personal records.