(Chicken Pox) History Form
Chicken pox (varicella)
is now a vaccine-preventable disease. Chicken pox can be a serious and even
life threatening illness in certain individuals. Several hospitals and
clinical agencies with whom EMTS is affiliated with for clinical experience
now require that we furnish documentation of a history of chicken pox
DOES NOT MATTER IF YOU HAVE HAD CHICKEN POX
IN THE PAST OR NOT.
Option 1) Provide Two (2) separate doses of Varicella vaccination.
*Note: Varicella vaccines are given a
minimum of 30 days apart. As long as student has documentation of
receiving 2 shots at this point in their life they are compliant.
*If the student has only completed 1 vaccination they must complete the
series and receive the 2nd shot for a total of 2 doses.
* If the student has only proof of 1 vaccination they must complete the series
and receive the 2nd shot for a total of 2 doses.
Option 2) If student has never received
any Varicella vaccinations or has no proof of any Varicella
vaccinations in the past the student may provide a titer lab report showing
Hepatitis B Immunizations
Current CDC guidelines are confusing and complex. If you have a
history of having a suppressed immune system please contact the school for
requirements. For those who are not immunosuppressed the CDC only
recommends a three shot series be completed and is valid for 22 years. Shot Series:
Typically it is a 3 shot series followed by blood work to verify results.
Fastest timeline: Shot #2 is give a minimum of 30 days after shot #1 and shot #3
is given a minimum of 2 months after the 2nd.
Option 1) Must provide appropriate documentation of receiving all
three immunization doses at any time prior to course due date.
* If student has records showing they
have started the series but not completed all 3 shots a titer will not
be accepted. Student must complete the entire series.
Option 2) If student has no proof of
any hepatitis B vaccines a titer test may be completed showing immunity.
A lab titer report must be provided.
Waiver applies to only those students who completed the series and immunity
cannot be obtained.
is a common and deadly infectious disease that is caused by mycobacteria.
TB most commonly affects the lungs but can also affect the central nervous
system, lymphatic system, circulatory system, bones and joints. An
injection (PPD) is typically given in the skin followed by a reading taken 48 to 72 hours
Option 1) Provide documentation of a
negative PPD TB skin test valid for 6 months prior to the end of the course
student registered for. NOTE: TB PPD documentation
from pharmacy, clinic and/or doctors office must provide: *Name of
manufacturer *Trade name given * Lot/batch #
*Signature/Initials who gave immunization *Date of
immunization given *Results in mm not just positive or negative.
Option 2) If student is not permitted to
complete a PPD TB test because of testing positive in the past the student
must provide documentation of the past positive test result and
complete one of the following;
a) Chest X-ray report
showing no TB present within 6 months prior to the end of the course student
b) T-Spot blood test report showing no TB present within 6
months prior to the end of the course student registered for.
does offer TB (PPD) testing in class for $15
which includes the reading of the test 48 to 72 hours after it was given.
Mumps, Measles, and Rubella
MMR vaccine childhood injection(s) as well as a adolescent/adult booster shot. CDC suggests that you have:
As a child students immunization records may not be documented as MMR
but rather lists the vaccines individually (mumps, measles, rubella).
Student need two rounds of childhood
measles, mumps and rubella injections at separate times as a child to not be
required to take an MMR adolescent/adult booster shot.
Option 1) Provide documentation of 2
separate rounds of MMR.
* May both be a child.
* May both be as adult/adolescent
* May be a combination of
childhood and adult.
Option 2) If student has
documentation of only 1 round of MMR but not two the student must complete
the series by getting another MMR booster.
Option 3) If student has no
recollection or documentation of any MMR shots a blood titer is acceptable
Tetanus/Diphtheria (Td) or Tetanus/Diphtheria/Pertussis (Tdap):
Tetanus: also known as
lockjaw, is a rare, serious, and preventable disease that affects the body's
muscles and nerves. It often arises from a skin wound that becomes
contaminated by the bacterium
Clostridium tetani, which is often found in soil. It is
not contagious. Tetanus/Diphtheria/Pertussis (Tdap): The
difference between Td and Tdap is that Tdap includes pertussis which is
EMT-B students: Td or Tdap vaccine
within 10 years is acceptable.
Advance Level Students: If Td within the last 10 years only, student will need a
solo pertussis immunization
(whooping cough) added within the last 5 years. If student have Tdap - pertussis was included in the
vaccine. Simple explanation: 1) You have
to have had a Tdap within the last five years.
Influenza - Will be required for the upcoming 2017-2018 flu season.
(Only applies to EMT-B classes that conduct clinicals between November 1st and March
healthcare workers should receive a flu shot. Dependent upon flu season
risk and clinical sites. At this time the standard seasonal flu shot is
required at all clinical sites.
Advance EMS Students:
Children's Medical Center requires season flu immunization year long.
If clinicals start and the current flu season immunizations are available
the student is required to be immunized.
NOTE: Flu documentation from pharmacy, clinic and/or doctors office
*Name of manufacturer *Trade name given * Lot/batch #
*Signature/Initials who gave immunization *Date of