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later.
5. MMR (Mumps, Measles, Rubella) immunization. (Two doses of MMR
separated by
more than one mouth and given on or after the first birthday eliminate the
need for 2, 3, 4 above.)
In the MOU, the SIUC Immunization Compliance Form requires by law reads:
The required immunizations on file at Student Health Services are as follows (DO
NOT FILL IN-on file already if on campus;
If student off campus site, MUST COMPLETE and submit to Internship Coordinator):
Tetanus/Diphtheria
Dose 1 ___________
Dose 2
___________
Dose 3
____________
Booster Dose __________ (within last 10 years)
MMR (Measles, Mumps, Rubella)
Dose 1 ___________
Dose 2
___________
Measles
Dose 1 ___________
Dose 2
___________
Or
Date disease diagnosed and certified by physician
____________
Or
Lab test proving immunity (attach lab report)
_________________
Rubella
Dose 1
___________
Or
Or
_________________
Dose 1 ___________
Date disease diagnosed and certified by physician ____________
Lab test proving immunity (attach lab report)
The following immunizations are optional for attendance at SIUC but I would
highly recommend and/or are required for HCM internship students to
receive the following due to possible exposure at your sites (*TB skin test-(required), **Hepatitis B, and ***flu vaccine{some facilities}). Students
interning at nursing homes, assistant living facilities or those working directly with
patients should seriously consider the following immunizations for your residents
safety and your safety:
Hepatitis B
Flu Vaccine
Meningitis
Varicella
Tdap Vaccine
Date
If you have any questions about the recommended immunizations, you may
contact the Student Health Services, 618 453-3311. Any questions regarding MOU
internships, please contact Dr. Beebe
(618 453-7202, 618 534-6470 or sbeebe@siu.edu).
Thank you,
Dr. S. N. Beebe
Health Care Management Internship Coordinator