**Student/Clinical Instructor credentialing will not be complete UNLESS all questions are answered on Northside Health History Form and proof of immunization is provided.**
Northside Employees are exempt from providing proof of immunization or completing the Health History From.
All supporting documents, with the exception of GRITS and School Immunization Records, must include official/authorized healthcare provider’s signature.
INFLUENZA VACCINE
TDAP VACCINE
MMR IMMUNIZATION
HEPATITIS B IMMUNIZATION
VARICELLA IMMUNIZATION
TUBERCULINE VACCINE
(Northside REQUIRES Annual QuantiFeron-Gold/T-Spot Blood Test)
Student/Clinical Instructor MUST provide proof of current negative QuantiFERON-Gold or T-Spot blood test result to attend clinical experience at Northside Hospital. The test result must be valid for the duration of the clinical experience.
Student/Clinical Instructor with previous proof of positive TST, must provide current QuantiFeron-Gold or T- Spot blood test result
NEW Positive Results
Student/Clinical Instructor assigned to work in High Risk Areas* MUST provide the following for clearance:
Proof of NEW POSITIVE QuantiFERON–Gold or T-Spot blood test result which must be valid for the duration of clinical experience at Northside Hospital AND
A current negative/normal Chest X-Ray which must be valid for the duration of clinical experience (one year from clinical experience End Date) AND
Evidence of INH or RIFAMPIN TREATMENT which includes the following:
a) Copy of the New prescription AND
b) Picture of first filled bottle showing the student name, medicine name and date prescription was filled
Student/Clinical Instructor assigned to Other Areas of the hospital MUST provide the following for clearance:
Proof of NEW POSITIVE QuantiFERON–Gold or T-Spot blood test result which must be valid for the duration of clinical experience at Northside Hospital AND
A current negative/normal Chest X-Ray which must be valid for the duration of clinical experience (one year from clinical experience End Date) AND
Negative screening for symptoms of TB (see Northside Health History form)
PAST Positive Results
Student/Clinical Instructor assigned to work in High Risk Areas* MUST provide the following for clearance:
Documentation of first positive reading/result - To confirm true positive results, student must provide proof of POSITIVE QuantiFERON–Gold or T-Spot blood test result AND
A current negative/normal Chest X-ray which must be valid for the duration of clinical experience (one year from the clinical experience End Date) AND
Evidence of INH or RIFAMPIN TREATMENT
a) On-going Treatment – Student to provide prescription refill log from either treating physician or County Public Health Department. Either documents must be signed. OR
b) Completed Treatment – Medical screening and clearance is required from the treating physician or County Public Health Department. The clearance must include the start and end date of treatment.
Student/Clinical Instructor assigned to Other Areas of the hospital MUST provide the following for clearance:
Documentation of first positive reading/result - To confirm true positive results, student must provide proof of POSITIVE QuantiFERON–Gold or T-Spot blood test result AND
A current negative/normal Chest X-ray which must be valid for the duration of clinical experience.(one year from the clinical experience End Date) AND
Negative screening for symptoms of TB (see Northside Health History form)
* High Risk areas are Women’s Services, Bone Marrow Transplant Unit, Oncology/Infusion Center, ICU, Respiratory Therapy and Child Development Center