Student Health Record Requirements
Workforce Development Center - Phlebotomy Technician Program
Health and Wellness Center Ira H. Rubenzahl Student Learning Commons (B19), Room 177 ChatNow Phone 413-755-4230 Fax 413-755-6045
Required Health Records and Submission Deadlines
Spring: Prior to December 1st
Fall: Prior to July 1st
Student Health History Form: required of all students enrolled at Springfield Technical Community College and must be updated every two years.
Authorization to Release Information to Fieldwork Sites Form: Read, complete and sign.
Technical Standards Acknowledgement — Phlebotomy form: Read the programmatic technical standards then read, complete and sign this form.
Criminal Offender Record Information (CORI) Acknowledgement Form: Annual requirement.
| Access to Campus | Authentication of Signature or Person |
|---|---|
| Not restricted | In person with original, valid, government-issued photo identification |
| Restricted | Verified by a Notary Public and submitted electronically via DropBox or Fax. |
Policies Acknowledgement Form: Student Background Record Check, Drug Screening for Fieldwork Placement, and Latex: All incoming students must review the policies and sign the form.
Verification of Health Insurance: All students participating in clinical fieldwork must have health insurance. Students enrolled in under 9 credits or non-credit courses should submit a front and back copy of their health insurance card.
Tuberculosis Screening: Two-Step tuberculin skin testing (PPD) or IGRA-serology (T-SPOT or Quantiferon-TB Gold) is acceptable. Results must be dated within 6 months prior to the course start date.
Two Step Skin Test is 4 Actions: The first PPD is planted and read (between 48-72 hours). To rule out a false negative: 7-21 days from the first plant, a second PPD is planted and read (between 48-72 hours).
OR
IGRA Blood test: T-SPOT or Quantiferon-TB Gold Note: CDC recommends IGRA for students who are BCG vaccinated
Students with a positive tuberculosis screening: Submit the positive result, a chest x-ray report completed within 12 months of the program start date and a completed Positive Tuberculosis Test Questionnaire Form to the Health and Wellness Center. The questionnaire is required to be completed annually thereafter.
Required Health Records and Submission Deadlines
Spring: Prior to December 1st
Fall: Prior to July 1st
Physical Exam: Student Physical Exam Attestation – Phlebotomy form is specific to the programmatic Technical Standards and is the only acceptable physical exam form. This form must be completed by a clinician and the exam must be within 1 year of the program start date and every subsequent 1½ - 2 years.
Immunization/Immunity Records:
- Tetanus, diphtheria and pertussis (TDaP) – evidence of vaccination within the past 10 years
- Measles, Mumps, Rubella (MMR) – evidence of two vaccinations or immune titer results for each component
- Hepatitis B – evidence of three vaccinations AND immune titer lab report results (surface antiBODY, anti-HBs)
- Varicella (chickenpox) – evidence of two vaccinations or immune titer results
- COVID-19 – evidence of vaccination
- Influenza – one vaccine dose for the current season must be on file by October 15th. Documentation must include: Name and DOB, date administered, manufacturer and LOT number, expiration date, Vaccinator's name and title.
- Meningitis –
- Students taking 12 or more credits - Menveo or Menactra dose required after 16th birthday for all students between 16 – 21 years old (these vaccines are known as MenACWY, formerly listed as MCV4) or signed meningitis waiver form
- For non-credit or part-time students - Vaccination is recommended to reduce risk of meningococcal disease
|
If TITER result is |
Then |
Action needed |
|
negative or indeterminate or equivocal |
It is considered a negative result/Student is not protected/immune |
Submit lab report to Health and Wellness Center
|
|
positive |
Student is protected/has immunity |
|
Background Check Submission Deadline
Spring: Dec 15th – Jan 15th
Fall: July 15th – Aug 15th
Background Check and Drug Screen | Invoice with Approval Package
Approximately 60-90 days prior to the start of fieldwork, students will be directed to order the national criminal background check and drug screening package via American DataBank/Complio. Drug screening must be completed prior to the assigned deadline. For more information please refer to the BACKGROUND CHECKING AND DRUG SCREENING POLICY FOR FIELDWORK PLACEMENT or contact compliance@stcc.edu.
The deadlines for record submission are set by the Workforce Development Center. Records must be submitted on time. Failure to meet the requirements set above may result in removal from the program. Extensions to deadlines are granted in only certain situations (i.e. late admission to a program, in the midst of some vaccination series). Deadline requests must be made in writing to the Director of Health Compliance using the Health Requirements Deadline Extension Request Form or via email to compliance@stcc.edu. All requests will be reviewed on a case-by-case basis. Submission of a deadline extension request does not guarantee an extension will be granted. Students may be excluded from fieldwork or clinical affiliations until requirements are met.
Go to www.stcc.edu/health-services for additional information and forms.
How to Submit Documentation
Documentation must include legal name, date of birth, date administered or date of exam or date of test. For lab results documentation must include the date of test, reference range, and result. Forms, vaccination records, lab, and imaging reports may be submitted to the Health and Wellness Center:
| In Person |
Building 19, Room 177 Appointment may be required. |
|---|---|
| Workforce Development Dropbox |
Upload pdf file or complete Electronic Form via links provided |
| Fax |
413-755-6045 |
| Release Request |