HEALTH REQUIREMENTS
ADN – Associate Degree Nursing Program - ONLY
Please read this packet carefully as some requirements have changed. Previous
versions of this packet are not in force and will not be honored. Note: Health
requirements are subject to change based on current medical advice,
practices, and are mandated by the clinical sites.
Note: Please see specific program registration or admission packets for detailed information on when to begin completing
health requirements, drug tests, CPR, criminal background checks and proof of insurance submission. Timing varies depending
upon either entrance to or participation in the clinical component of a given program. Funds paid to Edward Corporate Health
or to a personal health care provider, CastleBranch.com, insurance companies, and funds used towards CPR completion are not
eligible for any sort of refund from College of DuPage.
Health Requirements
Updated 05/19/16
Page 1
Health Requirements
The completion of all health requirements is mandatory as a student of the College of DuPage health career programs. The health
requirements may be completed by your physician, local hospital or clinic, or Edward Corporate Health Services. The background check
and drug screen must be completed through CastleBranch.com.
College of DuPage has contracted with Edward Corporate Health (ECH) to ensure compliance of students’ medical requirements. ECH
has provided College of DuPage students with special pricing. Please note that ECH does not accept personal health insurance. Any
charges are the student’s responsibility and are due at the time of service. It is recommended that students verify with their insurance
provider whether required services are covered by their personal health insurance. If so, you may choose to have those services
performed by a personal health care provider utilizing your health insurance. It is ultimately the student’s decision where they
complete their health requirements. ECH, or provider of your choice, may complete all of the services; however, ECH must complete
the required chart review. Please note: The College of DuPage will not receive any of your medical records; they are your and your
health care provider’s responsibility and property. ECH will provide a clearance form directly to you and the College of DuPage.
Once you receive the Health Clearance Form from ECH, you will then upload ALL of your health records (e.g. physical exam, proof
of flu vaccine, etc.) to CastleBranch.com. CastleBranch is medical document manager and you will have lifetime access to your
CastleBranch account.
To access ECH’s services, contact the various location(s) (see page 5), identify yourself as a College of DuPage student and discuss the
services you need. You must bring all required documentation to ECH for a Chart Review. Please do not complete these health
requirements until you are instructed to do so.
Health Requirements
Updated 05/19/16
Page 2
Health Requirement Pricing
Below is a list of required health services and the current fees charged by Edward Corporate Health. Students may also check their local
health department, convenient care locations or retail clinic, as they may offer some or all of the services. Students may also use their
health care provider for any or all of the services with the exception of the background check and drug screen, which must be completed
through CastleBranch.com. Please note that payment for the health requirements is the responsibility of the student, and
requirements and pricing are subject to change. The Chart Review must be completed by Edward Corporate Health and the student is
responsible for the fee. The Medical Document Manager tracking will be completed by CastleBranch.com.
******Pricing is determined by Edward Corporate Health and is subject to change without notice******
Contact information:
Edward
Hospital
Notes
See page 5 for locations and hours of
operation
Required Services:
Physical Examination (includes Color Vision)
$48
QuantiFERON TB Gold Blood Test
Note: This is an annual requirement
Rubella Titer (German Measles)
$80
Rubeola Titer (Measles)
$18
Varicella Titer (Chicken Pox)
$20
Mumps Titer
$20
Tetanus/Diphtheria/Pertussis vaccine (TDAP)
$63
Hepatitis B Titer
$20
Drug Test
$32
$20
This test MUST be completed through
CastleBranch.com
(See Page 11 for details and appropriate package codes)
Note: Drug Testing is an annual requirement
Flu Vaccine
NOTE:
The seasonal flu vaccine is an annual
requirement
Health Requirements
Updated 05/19/16
10 Panel: Marijuana, Cocaine, Phencyclidine,
Amphetamines/Methamphetamines, Opiates, Barbiturates,
Benzodiazepines, Methadone, Methaqualone & Propoxyphene.
*
*Pricing varies by clinic and season
The College of DuPage will provide an on-site flu clinic(s) – dates to be
announced.
NOTE: Your flu vaccine documentation must include: (1) Student name, (2)
Clinic name, (3) Clinic address (4) Date administered, and
(5) Lot# of vaccine.
Page 3
Chart Review
$30
Medical Document Manager –
This is the FINAL step that is taken after you
have been “CLEARED” by Edward Corporate
Health (ECH). The Medical Document Manager
service MUST be completed through
CastleBranch.com.
$35
Background Check – This MUST be
completed through CastleBranch.com.
$46
Total
Health Requirements
Updated 05/19/16
Service MUST be completed by ECH
Service MUST be completed through CastleBranch.com. The above
records will be managed through CastleBranch creating a personal
profile/tracker.
(See Page 11 for details and appropriate package codes)
This MUST be completed through CastleBranch.com.
(See Page 11 for details and appropriate package codes)
$432*
This is an estimate, as services will vary by individual student’s health history
and records. *Prices are subject to change.
Page 4
Edward Locations
Please visit Edward Corporate Health’s website at: www.edward.org/11447.cfm
You MUST visit one of these locations in-person in order to complete a Chart Review.
Edward Occupational Health/Naperville
801 S. Washington St.
Naperville, IL. 60540
(Follow signs for Corporate Health. Located adjacent to Pediatric Department.)
Schedule an appointment or general information:
(630) 961-4948
Hours:
Monday – Friday: 7 a.m. - 4:00 p.m.
Edward Occupational Health/Bolingbrook
130 N. Weber Road, Suite 108
Bolingbrook, IL. 60440
(1/4 mile south of Boughton Road)
Schedule an appointment:
(630) 646-5731 or (630) 961-4948
Hours
Monday – Friday: 8 a.m. to 8 p.m.
Saturday – 8 a.m. to Noon
(closed on Sundays and holidays)
Edward Occupational Health/Plainfield
24600 W. 127th Street
Plainfield, IL. 69585
(127th and Van Dyke Road)
Schedule an appointment:
(815) 731-3000
Hours:
Monday - Friday: 8 a.m. to 4 p.m.
Health Requirements
Updated 05/19/16
Page 5
TO AVOID MULTIPLE TRIPS TO YOUR PROVIDER AND/OR EDWARD CORPORATE HEALTH,
PLEASE DO NOT BEGIN HEALTH REQUIREMETNS PRIOR TO ATTENDING ORIENTATION
COLLEGE OF DUPAGE
HEALTH REQUIREMENTS INFORMATION AND CHECKLIST
***Note: Health Requirements are subject to change based on current medical advice, practices, and are
mandated by the clinical sites***

WHEN
COMPLETED
REQUIREMENT
ADDITIONAL INFORMATION
Confidential Medical History form
to be completed by YOU!
To provide health care
provider with an overview
of your medical history
Complete and take with you for your
Physical Examination
Physical Examination
Report
A summary of the physical exam
performed by your primary care
provider (i.e. MD, NP, PA)
To ensure you are able to
perform the role of the
profession for which you
are preparing
Equal to a school or sports physical; must
be done within 12 months of starting the
program
Immunity for:
_______
WHY
Medical History
_______
_______
WHAT
MMR
 Measles (Rubeola)
 Mumps
 Rubella
Documented antibody titer levels
indicating immunity (blood draw to
demonstrate your immune status
to identified communicable
diseases). To be effective, the
blood test must indicate that you
are positive for immunity.
To ensure your ability to
“fight” communicable
disease and/or prevent the
spread of it.
For negative or equivocal titer results:
If vaccination series was previously
administered, one booster is required. Titer
is to be completed 4 weeks subsequent to
administration of booster.
If vaccination series has not been previously
administered, the series must be completed
and followed by a titer 4 weeks subsequent
to the completion of the series.
Varicella – (Chicken
Pox)
Students may go to clinical site if the
vaccine series is in process (some clinical
site exclusions apply). Students must
complete their series of live vaccines
within 4 weeks followed by a positive
titer.
Hepatitis B
______
Health Requirements
Updated 05/19/16
Documented antibody titer levels
indicating immunity (blood draw to
demonstrate your immune status
to identified communicable
diseases). To be effective, the
blood test must indicate that you
are positive for immunity.
To ensure your ability to
“fight” communicable
disease and/or prevent
the spread of it.
For negative or equivocal titer results:
The complete vaccine series must be
completed as follows:

1st dose administered

2nd dose administered 4 weeks
subsequent to the first dose

3rd dose administered 5 months
subsequent to the second dose

Titer is to be completed 4 weeks
subsequent to completion of
series
Students may go to clinical site if the
vaccine series is in process (some clinical
site exclusions apply).
Page 6
_______
QuantiFERON-TB Gold
Blood Test
Blood test that aids in the
detection of Mycobacterium
tuberculosis, the bacteria
which causes tuberculosis (TB)
Proof that you are free of
Tuberculosis
A positive QuantiFERON-TB Gold result
means that the person has been infected
with TB bacteria and should be followed
by further medical and diagnostic
evaluation to determine if the person has
latent TB infection or TB disease
Gain immunity to Tetanus,
Diphtheria and Pertussis
Current medical advice indicates that this is
a necessary vaccination to protect students
entering a health care facility from noted
diseases
_______
Tdap
Tetanus, Diphtheria and
Pertussis vaccination
Vaccination is given and covers
three diseases
_______
Drug Test:
Must be completed
through CastleBranch
A urine test for presence of
Proof of being drug
identified drugs. The drug test must free
be a 10 panel.
Must be administered within 90 days or less
prior to the students first day of class.
(Refer to final page for appropriate package
code and further details).
Flu Vaccine
Vaccine given annually
Must have proof of flu vaccine for current
flu season. Can be waived for documented
allergy or religious reasons only.
Flu vaccine documentation must include the
following: (1) Student name, (2) Clinic
name, (3) Clinic address (4) Date
administered, and (5) Lot# of vaccine.
_______
NOTE: The flu vaccine is seasonal
and changes every year in the Fall.
Chart Review
All Medical Records must be
Medical personnel are
reviewed by Edward Corporate
reviewing student’s
Health. A clearance form will be
medical records
provided upon completion. You will
then upload the clearance form to
your CastleBranch tracker.
Students are to either bring all completed
requirements to Chart Review appointment
or have the testing/physical done at
Edward Corporate Health. A charge applies
to this chart review and is the students’
responsibility. Please allow plenty of time
to get all requirements completed and
reviewed by Edward Corporate Health.
Background Check
Background Checks are completed
through CastleBranch.com
Refer to final page for appropriate package
code and further details.
_______
_______
_______
Minimize risks of acquiring
the flu
Must be completed
through
CastleBranch.com
Medical Document
Manager through
CastleBranch.com
(submission of Health
Records)
Once Edward Corporate Health
provides you with a clearance form,
ALL Medical Documents must be
uploaded to CastleBranch.com
CPR Card
Must be American Heart
Association – Basic Life Support for
Health Care Provider. Card must be
signed by student.
_______
Medical Insurance
_______
Health Requirements
Updated 05/19/16
Proof of personal health insurance or
may be purchased through the
college (University Health Plans or
Integrity Insurance and Financial).
Please visit Center For Access and
Accommodations website for details.
Your medical documents
will be maintained in a
secure web-based
management system
Students will have unlimited access to their
Medical Documents
(Refer to Page 11 for appropriate Package
Code and further details).
Expiration date must be after completion
date of the program
Required by clinical sites
Must be valid through entire length of
chosen program
Page 7
PHYSICAL EXAMINATION REPORT
COLLEGE OF DUPAGE
425 FAWELL BLVD., GLEN ELLYN, ILLINOIS 60137
Please Print
Name
Last
First
Health Program
Date of Birth (MM/DD/YYYY)
SS#
-
-
Must be completed by a licensed medical professional
Height
Weight
Blood Pressure
Pulse
Physical Findings - Must be completed by a licensed medical physician, nurse practitioner or physician assistant.
Body Systems
Cardiovascular
Eye
Ear, Nose, Throat
Conversational Hearing
Color Vision
Gastrointestinal
Metabolic-Endocrine
Musculoskeletal
Neurological
Respiratory
Skin (Exposed areas only)
Lymph Nodes
Normal
Abnormal, please describe
Is student presently under any medical treatment? If yes, please explain:
Conclusion: (check one)
□ The
student is medically cleared to perform essential functions defined by the health programs of College of DuPage, and the
career being educated for.
□ The
student is medically cleared to perform essential functions defined by the health programs of College of DuPage, and the
career being educated for with the following accommodation(s)/restriction(s).
□ The
student has not been medically cleared to perform essential functions defined by the health programs of College of DuPage,
and of the desired healthcare career.
Examiner’s Name (Please Print)
Date of Examination
Signature of Examiner
This physical exam satisfies the requirements of all College of DuPage
Health Science programs and all clinical sites.
Health Requirements
Updated 05/19/16
Page 8
Edward Hospital
801 S. Washington St.
Associate Degree in
Nursing Students
(A.D.N.) ONLY
Naperville, IL 60540
EDWARD CORPORATE HEALTH CLEARANCE FORM
******Form is filled out by Edward Corporate Health - NOT STUDENT******
College of DuPage
Program Name:
Associate Degree Nursing Program
Be advised that: LAST NAME: __________________________________ FIRST NAME:______________________________________
(PLEASE PRINT)
□ Physical Exam/ Basic
Date:_______________
The student is medically cleared to perform essential
functions defined by the health programs of College of
DuPage, and the career being educated for.
□ Flu Vaccine: Date: ______________________
□ Hepatitis B Titer
Clinic Address: (if given at ECH say “see above”)
__________________________________
Titer date:__________ Result:___________
___________________________________
Negative or Equivocal Titers:
Lot #: ______________________________
□ Flu declination (Doctor’s note documenting allergy or letter
from Religious clergy MUST accompany this form, otherwise
student cannot decline the flu vaccine).
(Must be completed within 90 days of clinical start)
Result:_________ Expires: ___________
Only If medically necessary:
□ Chest X-Ray
Date:________________
(Must be completed within 90 days of clinical start)
Result:_______ Expires: ___________
□ Annual TB Questionnaire
Date:___________
“Negative” Chest X-Ray in past? (circle) Yes OR No
Date of “Negative” Chest X-Ray: _____________
□ Tdap Date: _______________
□ Color Vision:
Pass: (circle) Yes OR No
Fail: (circle) Yes OR NO
Health Requirements
Updated 05/19/16
HEPATITIS B:
For negative or equivocal titer results:

The complete vaccine series must be completed. Titer is to be
completed 4 weeks subsequent to completion of series.
Clinic Name:____________________________
□ QuantiFERON-TB Gold Blood Test
□ QuantiFERON-TB Gold test: Date: __________
Immunity (status) – Positive Antibody Titers Required
for: Hep B, Varicella, and MMR.
□ Vaccine Series
□ 1 Administration ___________________
□ 2 Administration___________________
□ 3 Administration ___________________
□ Titer Date ______________ Result _____________
st
nd
rd
VARICELLA & MMR:
For negative or equivocal titer results:

If vaccination series was previously administered, one
booster is required. Titer is to be completed 4 weeks
subsequent to administration of booster.
•
If vaccination series has not been previously administered,
the series must be completed and followed by a titer 4 weeks
subsequent to the completion of the series
□ Varicella Titer
Titer date:___________ Result:__________
Negative or Equivocal Titer:
□ Booster Date __________
□ Repeat Titer date:___________ Result:____________
Continued on Next Page
Page 1 of 2
Page 9
□ Vaccine Series
□ 1 Administration ___________________
□ 2 Administration___________________
□ Titer Date ______________ Result _____________
st
nd
MMR – Measles (Rubeola), Mumps, Rubella
□ Measles (Rubeola) Titer
Titer date:___________ Result:__________
□ Mumps Titer
Titer date:___________ Result:__________
□ Rubella Titer
Titer date:___________ Result:__________
Negative or Equivocal Titers:
□ Booster Date __________
□ Repeat Titer date:___________ Result:____________
□ Vaccine Series
□ 1 Administration ___________________
□ 2 Administration___________________
□ Titer Date ______________ Result _____________
st
nd
Recommendations: If you have any questions or concerns, please feel free to call Edward Corporate Health at (630) 961-4948.
1.
Has been medically cleared by the examining physician to perform the job duties without physical restrictions.
2.
Records have been reviewed. Based on submitted information is cleared to perform job duties without physical restrictions.
3.
Cleared with the following restriction (Restrictions may prevent acceptance into program).
____________________________________________________________________________________________________
4.
Based on Physician’s report and/or other diagnostic findings, student is NOT medically cleared for the health program at the College
of DuPage.
______________________________________________________
Signature
_______________________________________
Date
Health Requirements
Updated 1/27/16
Page 10
Page 2 of 2
Student Instructions: Background Check, Drug Test & Medical Document Manager
***Do Not Complete Until Instructed***
CastleBranch is a secure platform that allows you to order your background check, drug test &
medical document manager online. Once you have placed your order, you may use your login
to access additional features of CastleBranch, including document storage, portfolio builders
and reference tools. CastleBranch also allows you to upload any additional documents required
by your school.
To Place Your Order:
1.
Go to: portal.castlebranch.com/CV72
2.
Choose the package code from the list:
3.
You will then be directed to set up your CastleBranch account. If you have any questions,
please contact the CastleBranch Service Desk Representatives:
Health Requirements
Updated 1/27/16
Page 11