Virginia Appalachian Tricollege Nursing Program

Student Forms - 2nd Year Students

Submit all documentation in a single packet to the VATNP Office at VHCC, PO Box 828, Abingdon, VA 24212 by August 1.

1. Annual Student Statement Of Health Form
   This form verifies the student’s ability to perform clinical activities. This statement of health form must be renewed and submitted every year before August 1st to the VATNP office at VHCC, while enrolled in clinical courses. This form is to be filled and signed by the student. Send the original document, make a copy for yourself.
   
   
2. 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.
   
   
3. 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 of insurance that includes the amount and dates of coverage. Insurance policies can be obtained at www.nso.com or www.proliability.com. You must choose the policy that covers you as a registered nursing student. LPN’s must also have coverage as a licensed LPN. 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. LPN’s must have coverage as a licensed LPN.
   
   
4. 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.
   
   
5. Hepatitis B
   Submit proof of hepatitis B vaccinations. 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:

   1. 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.
   2. 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.
   3. 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.

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.