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Health Forms

These are the Clinical Requirements for the following students:
Nursing, Cardiovascular Technology, Radiologic Technology, Emergency Medical Services, Physical Therapist Assistant,
Medical Laboratory Technician, Diagnostic Medical Sonography, Dental Hygienist.

Please be sure you read the dates for when you can actually complete the Criminal Background Check and the Urine Drug Screen tests. See Health Form instructions for completion dates.   If the dates that you complete these two items are not during the appropriate times, or if you pay and process before  dates listed, you may have to REDO and REPAY for them to be done during the appropriate time frame.

Health Form Deadlines are as follows:  

NursingDue DateProgramDue Date
Summer Admission
(Accelerated)
April 10Radiologic TechnologyMay 1
Fall AdmisisonJuly 10Physical Therapist AssistantJuly 10
Spring AdmissionDecember 10Cardiovascular TechnologyFebruary 1
LPN-RN Pathway (N103)Summer admit-June 1Diagnostic Medical SonographyDecember 10
LPN-RN Pathway (N103)              Fall admit-September 1Dental HygienistJuly 10
LPN-RN Pathway (N103)Spring Admit-February 1Medical Laboratory TechnicianDecember 10
ProgramDue DateProgram  Due Date
EMS-Paramedic-FallAugust 10EMT Fall admission               August 10
EMS-Paramedic-SpringJanuary 10                EMT Spring AdmissionJanuary 10
  EMT Summer AdmissionMay 10

*STUDENTS MUST MAKE A COPY OF ALL CLINICAL/HEALTH DOCUMENTS AND KEEP AS A PERSONAL FILE PRIOR TO SUBMISSION. 
THE HSD CLINICAL COORDINATORS WILL NOT BE ABLE  TO PROVIDE  ADDITIONAL COPIES OF ANY HEALTH DOCUMENTS AFTER SUBMISSION.*

NEW STUDENT FORMS AND LINKS:

ANNUAL UPDATE FORMS:

  • Tuberculosis Questionnaire (for those with a history of a positive PPD) *Due Annually
  • PPD Form (for those with negative PPDs) *Due Annually
  • Flu Form *Due Annually
  • Flu Waiver *Only submitted once, must have a medical, religious, or moral reason. Note that some facilities may not accept moral reasons which may endanger your clinical attendance.