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Clinical Criteria

Forms for Nursing Students


The MSOE Health Record must be completed on entrance to MSOE and on file in Health Services (K250).  You are to document required immunizations as noted below and will find the required physical exam with this MSOE Health Record.

A one-time physical exam (Within the year of your first clinical) by your private physician or MSOE Health Services Nurse Practitioner.  This form must be completed, signed and on file in Health Services, K250 by July 31, before the beginning of your first clinical year.

The following immunizations must be completed and the dates must be recorded:

 

  1. Tetanus, Diphtheria, Acellular Pertussis Booster - Must have a one time booster of Tdap within the last 10 years. Tdap (includes Acellular Pertusis/Whooping Cough) came on the market in 2005; it is recommended for all incoming freshmen and may be given at any time from your last Td date.
  2. Measles, Mumps, Rubella (MMR) – All nursing students born in the U.S. prior to 1/1/1957 must demonstrate immunity to Rubella (German Measles) by proof of one MMR vaccine or a positive Rubella titer per copy of lab report. If born after 1/1/57, immunity to both Rubella and Rubeola (measles) must be demonstrated by proof of two MMR vaccines (given at least 29 days apart) or positive Rubella and Rubeola titers.
    Vaccinations may have been given separately. We must see two dates for measles, two dates for mumps and one date for Rubella. If unable to provide date of vaccinations, you must provide Serology proof of immunity. Titers can be ordered by your doctor.
  3. Hepatitis B - three doses; list all three dates. If no previous vaccinations, must be in process before beginning of Sophomore clinicals. 
  4. Varicella (Chicken Pox) - History of actual disease or positive titer or two doses of vaccine given at least one month apart.  

Many insurance plans or HMO's cover the cost of immunizations; if this is not available to you, please check out your local public health department for best cost containment, or visit MSOE Health Services website.

MSOE understands that some students cannot have immunizations due to health or religious reasons. If these pertain to you, please have your physician and or minister document this and complete declination form found in the School of Nursing. This must be on file in Health Services (K250)



All Annual TB skin test documentation must be on file in the School of Nursing, S201 by July 31 before the beginning of each clinical year. (There is a $5 charge if given by Health Services; this will be paid through your student account.) Annual clinics are held each May at the SON; TB clinic dates will be announced each spring. If unable to make these clinics, you may schedule in Health Services (414) 277-7590 on a Mon. or Tues. Tests are to be read within 48-72 hours by Health Services K250 or by a clinical instructor. The student is responsible for making sure that results are turned in to the School of Nursing S201. If you have questions, please contact the SON (414-277-7158) or Health Services (414-277-7590). ** For anyone who has had a positive TB skin test, the SON must have documentation of one negative chest x-ray for TB and completion of a risk assessment annually. Students who have tested positive are required by Children's Hospital to have documentation of a negative chest x-ray within one year of their clinical at CHW.