Student Forms - Entering LPN-RN Students or Readmitted To The VATNP Nursing Program
- Required Student Forms And Documentation Checklist
Checklist of required documentation for enrollment into the nursing program. This form is to be completed and returned to the VATNP office along with all other documentation. - Annual Student Statement Of Health Form
This verifies the student’s ability to perform clinical activities. This statement of health form must be renewed and submitted every year by stated deadlines to the VATNP office at VHCC, while enrolled in clinical courses. This form is to be filled out and signed by the student. Send the original document, make a copy for yourself. -
Student Information, Physical, and Immunization Form
This form is to be completed and signed by a licensed health care provider and student as indicated. Please make sure that the form is completely filled out, including health care provider information. This form is required upon entry or readmittance to the nursing program. Forms left with blank entries will not be accepted as complete. Send the original document, make a copy for yourself. LPN-RN students should have physical after April 1. - Measles (Rubeola) – Proof of two immunizations of live measles virus vaccine on or after first birthday or titer results showing immunity.
- Mumps – Proof of two immunizations with live mumps vaccine on or after first birthday or titer results showing immunity.
- Rubella – Documentation of Rubella immunization on or after first birthday or titer results showing immunity.
- Where a licensed physician provides documentation
that the vaccination is contraindicated for one of the following
reasons:
- the individual meets the criteria for contraindication set forth in the manufacturer's vaccine package insert;
- the individual meets the criteria for contraindication published by the U.S. Centers for Disease Control of the ACIP; or
- in the best professional judgment of the health care provider, based on the individual's medical condition and history, the risk or harm from the vaccine outweighs the potential benefit.
- An individual who has been exempted from a particular vaccination must comply with immunization requirements for any vaccines from which he/she has not been exempted.
- Where a parent or guardian, or in the case of an adult student, the student, provides to the school a written statement, affirmed under penalties of perjury, that vaccination conflicts with the religious tenets and practices of the parent or guardian, or in the case of an adult student, the student.
- Varicella vaccination - documentation is required from a nurse practitioner, physician assistant, medical doctor, or appropriate health care provider with the dates of injections.
- Positive titer and date of varicella stated as "immune" signed by a nurse practitioner, physician assistant, medical doctor or appropriate health care provider.
- A signed verification and date of varicella disease - documentation is required from a nurse practitioner, physician assistant, medical doctor, or appropriate health care provider.
- Declaration of Varicella – student signed
- CPR (Cardiopulmonary Resuscitation)
Proof of current certification in "Basic Life Support (BLS) for Healthcare Providers" by the American Heart Association. The CPR certification must be for two years and cover the entire period of enrollment in the nursing program. A copy of your signed CPR card, front and back is required. Totally online BLS courses are not acceptable. CPR classes may be offered at community colleges, local hospitals or by contacting the American Heart Association at: www.americanheart.org. - Health Insurance Portability and Accountability Act (HIPAA)
Certification is required of all nursing students. HIPAA certification must be completed by each student even though HIPAA training may have been completed through another agency. You are required to complete two certificates and submit the copies in your paperwork packet. The HIPAA certificates are: Understanding HIPAA - a text-based overview of the statute (30 minute seat time) and Accessing and Sharing PHI - discovery based learning (90 minute seat time). Please contact HDM (Deb Huston) at 1-888-944-4722 for payment and log in information. - Professional Liability Insurance -
Proof of current professional liability insurance in the minimum amount of $2,000,000/4,000.000. Documentation must be a copy of the certificate or the memo of insurance that includes the amount and dates of coverage. Insurance policies can be obtained at www.nso.com or www.proliability.com. If the website does not show a 2/4 million policy, please contact customer service and ask if that policy is available. If a letter from the school is required stating that the 2/4 million policy is a requirement, a copy of the letter may be found at the VATNP Website, under Student Forms, paragraph 4, Professional Liability Insurance Requirement. You must choose the policy that covers you as a nursing student. If you choose to pay by check or money order, it may take up to two weeks to receive your certificate of insurance so please plan accordingly. Insurance coverage must be carried during your entire time as a nursing student.
- Background Checks and Drug Screens
Healthcare facilities require nursing students to have certified criminal background checks and drug screens. The VATNP uses www.certifiedbackground.com for these services. Students register for both the certified criminal background check and drug screen at the certified background website listed above in order to participate in clinical courses. This process typically takes a minimum of 10 days to complete so please plan accordingly. First-year students entering nursing classes in the fall semester should pay for and complete their background check and drug screen in July. LPN-RN students should order and complete this in May. The only document that is to be returned to the VATNP office at VHCC is the Certified Background release completely filled out and signed. The cost of the check and screen is the responsibility of the student.
DO NOT send any receipts, confirmations, or background/drug screen results to the VATNP office, they will be shredded. The cost for both the criminal backgrounds check and drug screen will be paid for by the student online.To Register with CertifiedBackground
Step 1: Go to www.certifiedbackground.com- Click on STUDENTS.
- Enter package code: IR79
- Click SUBMIT.
- Proceed to checkout and pay the fee
- Print the confirmation.
Step 2: Your payment to CertifiedBackground includes a drug test that must be done through a Quest Diagnostics laboratory. To find a Quest Diagnostics Laboratory for the Drug Screen:
Go to: www.questdiagnostics.com and then click on “Find a Quest Diagnostics Location”.
- Enter address information
- Select Reason for Testing
- Click on:
- Employer and wellness services
- Drug testing
- Non-regulated testing
- Urine Drug Screen
- Paper CCF or Electronic CCF
- Search
After registering for the drug screen an electronic CCF (Custody and Control Form) will be sent to you through your email. Not all lab locations accept the electronic CCF. Check with the Quest Diagnostics location to verify if an electronic CCF can be used. If a paper CCF is needed, you must appear in person to pick up the form at one of the offices below. Bring your confirmation email from CertifiedBackground and a photo ID.
- Virginia Highlands Community College – Rachel Law, VATNP office, NEB 944, call 276-739-2439
- Southwest Virginia Community College – Tammy Austin, the Armory, enter behind the building, office number 139, call 276-964-7306
- Mountain Empire Community College – Debbie McConnell, Robb Hall 103,call 276-523-7456
Note: Normal office hours are typically 8:30 – 4:30, but it is a good idea to call to make sure that someone will be available to help you as schedules (summer in particular) can be flexible.
Step 3: Take the Custody and Control form to a Quest Diagnostics laboratory. It is a good idea to contact the testing site to confirm hours and location. If there are questions about the background check or the drug screen, please call the CertifiedBackground Customer Service number at 888-723-4263 ext. 7194.
Step 4: The results of your background check and drug screen will not be posted online to your account until the drug screen step has been completed. Once this is done, results can be viewed online at the CertifiedBackground website. The VATNP receives a report that shows if the tests have cleared or not cleared. If applicants do not clear the check, the VATNP Dean will contact the student to advise them of their status. Students will not be allowed to participate in clinicals without a cleared background check and drug screen. Clinical agencies reserve the right to ask students for access to their CertifiedBackground account at any time. Refusal to allow access to clinical agencies may result in the agency refusing to allow the student to continue clinical activities at that facility; which may prevent the student from being successful in the clinical course and progressing in the nursing program.Step 5: Complete the Certified Background release (click on link for form) and turn in to the VATNP office.
Mantoux Tuberculin Skin Test
(TB Tine test is not acceptable) - Proof of a negative TB skin test
must be obtained every year and should not expire during the clinical
experience. This screening is to be renewed annually. The results of the
test must be signed by a licensed health care provider showing the date of testing, date of reading, and results
recorded in millimeters of indurations. Students who are known positive
reactors or who cannot be tested must provide a negative chest
X-ray and yearly physician documentation of negative physical signs and
symptoms of tuberculosis.
Procedure for Mantoux Tuberculin Skin Test - Give 0.1 ml 5 TU PPD intradermal injection in a
forearm. Read test in 48-72 hours. If reading (indurations) is 5mm
or greater, the test is positive for certain persons at increased risk;
15mm or greater is considered positive for healthy people who are not at
risk.
MMR (Measles, Mumps, & Rubella)
Persons who cannot document prior MMR vaccinations must provide titer
results. If titer results are negative, two doses of MMR separated by at least 4 weeks
are required.
Note: Your high school vaccination record is a valid document to show proof
of immunization.
Hepatitis B
A new ruling for hepatitis B vaccinations will be in effect starting
July 1, 2011. This applies to all nursing students first and second
year, day and evening/weekend. You are required to provide
proof of the completion of hepatitis B immunizations, positive
titer, or documentation supporting one or more of the exemptions
listed below with your nursing paperwork that is required by August
1, 2011. If you do not have documentation as outlined below
you will not be able to participate in clinicals. A
declination is no longer acceptable documentation. If you need
to have the series, please begin it immediately; it takes a minimum
of 5 months to complete.
Effective
July 1, 2011, unless exempted by law, any student enrolled in
a higher education institution who is a health science student
expected to have patient contact shall present proof of protection
against hepatitis B before patient contact begins. For
purposes of this paragraph adequate immunization is defined as: 1) a
complete hepatitis B vaccination series or 2) laboratory evidence of
immunity.
An individual may be exempted from the requirements only under the following circumstances:
Hepatitis B Vaccination Schedule - First dose at elected date. The second dose at least 4 weeks after the first dose; the third dose should be given at least 8 weeks after the second dose and at least 16 weeks after the first dose. Administer missing doses to complete a 3-dose series of hepatitis B vaccine to those persons not completely vaccinated.
Varicella (Chicken Pox)
Students must have one of the following:
Tetanus (Td) - Proof of Tetanus immunization received within the past 10 years. If immunization is not within past ten years, one is required by the clinical agencies. Student should have immunization every ten years. Verification of tetanus must be signed by a nurse practitioner, physician assistant, medical doctor, or appropriate health care provider.
