PIERCE COLLEGE EMS PROGRAMS

Prerequisites

Student Name: ______

ALL shots listed below are required to be given on an official shot record or clinical document. Records provided to us must show the date the vaccination/titer/booster was given, your name, and the medical provider in order to be eligible for enrollment.All immunization or shot records are due on or before Mandatory Orientation date.

You will be provided an informational sheet that details all immunization criteria.

Please submit all pre-requisites as you complete them to

Shot record with proof of:

MMR ______MMR______

Tdap______, (Tdap shot or booster must be less than 10 years old.)

HepB ______, HepB ______, HepB ______

Varicella (Chicken Pox) ______Varicella (Chicken Pox) ______

Titer (blood draws) are acceptable as long as they show immunity for the above vaccinations.

Shot record with TB tine test______

(Taken within last year and must be valid through the duration of the term)

Current season Flu shot required Aug 2016-April 2017 ______

Current American Heart Association “Healthcare Provider” or Red Cross “Professional Rescuer” CPR card.

*List of some available CPR classes in the area provided by request on page 5.

POST EMT ORIENTATION PREREQUISTES

Civilian students provide printout of the completed Training Modules from Clinical Placements Northwest (CPNW)

Military students provide a printout of NEO 66 certificate

**Please note** Allstudents will be provided with a referral for both the background check(s) and the drug test (10 panel eCup/eReader certificate) at EMT Mandatory Orientation. Please do not initiate either of these processes prior to being instructed to do so at Orientation as they are only valid for 90 days. You will be provided with referrals at orientation.

No students will be admitted into program without attending Mandatory Orientation

****Mandatory Orientation: June 15, 2017 @ 0830-1330 OR 1730-2230****

NO EXCEPTIONS

Clinical Placements Northwest

Student/Faculty

Clinical Passport Requirements

SUBMIT ONCE

HEPATITIS B

  • Documentation of Series of 3 vaccines completed at appropriate time intervals and post vaccination titer at 6-8 weeks after series completion. If negative titer, then repeat series (consisting of doses #4-#6) and repeat titer 6-8 weeks after #6 dose; or obtain challenge dose #4 and re-titer after 6-8 weeks OR
  • Provide documentation of positive titer (anti-HBs or HEPB Sab) OR
  • Signed declination for students/faculty who decline vaccination Specific healthcare institutions may require vaccination without exception (i.e. no declination).

MMR (Measles, Mumps, Rubella)

  • Proof of vaccination - 2 doses at appropriate intervals OR
  • Proof of immunity by titer

VARICELLA (Chicken Pox)

  • Proof of vaccination - 2 doses at appropriate intervals OR
  • Proof of immunity by titer

TETANUS, DIPTHERIA, PERTUSSIS (Tdap)

  • Tdap required once
  • TD required every 10 years

CPR

  • Courses can be American Heart Association (AHA) BLS Provider
  • Military Training Network (MTN) course
  • Heartcode BLS Course

SUBMITTED EVERY YEAR

TUBERCULIN STATUS

  • Annual TST OR
  • Annual TB IGRA test
  • If newly positive TST/IGRA results – F/U with healthcare provider (chest X-ray, symptoms check and possible treatment documentation of absence of active M. TB disease) and may need to complete health questionnaire.
  • Previously documented positive TST results and prior negative chest results: submit annual symptom check completed with one year from healthcare provider.

INFLUENZA

  • Proof of seasonal vaccination (s) OR

Signed declination for student/faculty who decline vaccination (specific healthcare institutions may require vaccination without exception (i.e. no declination)