HEALTH REQUIREMENTS
(Excludes: Associate Degree Nursing, Basic Nursing Assistant
(BNA), EMT, Medic to PN and Paramedic programs)
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/ source, CastleBranch (previously CertifiedBackground) insurance companies, and funds
used towards CPR completion are not eligible for any sort of refund from College of DuPage if the required course(s) are not
successfully completed.
Health Requirements
Updated 04/12/16
Page 1
Health Requirements
You must complete the health requirements as a student of the College of DuPage (COD) health career programs. For any or all
the requirements listed, you may use your physician, local hospital or clinic, or Edward Corporate Health Services; there is
one exception, the drug screen must be done through wwww.castlebranch.com (previously CertifiedBackground).
COD has contracted with Edward Corporate Health (ECH) to insure compliance of students’ medical requirements. ECH has
provided COD 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. We would highly recommend that students investigate if
required services are covered by their personal health insurance. If they are, feel free to have those services performed by
their personal health care provider. It is ultimately the student’s decision as to where to get their health requirements
completed. ECH, or any other provider of their choice, can do all of the services but ECH must do the required chart review.
Please note: College of DuPage will not receive any of your medical records; they are you and your health care provider’s
responsibility and property. ECH will provide a clearance form directly to you and College of DuPage.
To access ECH’s services, call the various location(s) (see page 5), identify yourself as a College of DuPage student and discuss
what services you need. You must bring all required documentation to ECH for a Chart Review. Depending upon the program
to which you are applying, medical requirements may need to be completed prior to registration for the class/program.
Some programs will set a date that is after registration but before actual participation in the class. Please note and adhere
to your specific program’s requirements.
NOTE: This paragraph does not apply to Central Sterile Processing (SURGT 1111) students:
Once you receive the health “clearance form” from ECH, you will then upload ALL your health records (ie. Physical exam,
proof of HepB, proof of flu vaccine, etc) to www.castlebranch.com (previously CertifiedBackground). Castle Branch is Medical
Document Manager Provider. You will conveniently upload ALL of your records to them. You will have unlimited access to all
your health records beyond graduation.
Health Requirements
Updated 04/12/16
Page 2
Health Requirement Pricing
Below is a list of 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 use their own
physician for any or all of the services with the exception of the drug screen and background check, which must be done through
CastleBranch (previously CertifiedBackground). Please note that the cost of these health requirements is the responsibility of the
student, and requirements and pricing are subject to change due to conditions in the health care settings/environment. The Chart
Review must be done by Edward Corporate Health and the student is responsible for the fee. The Medical Document Manager tracking
will be done by CastleBranch and you, as a student, will always have access to your medical records.
******Pricing is determined by Edward Corporate Health and is subject to change without notice******
Edward
Hospital
Notes
Note: Second-year pricing is the same as the first-year required services.
Contact information:
See page 5 for locations and hours of
operation
Services Offered
Physical Examination (includes Color Vision)
TB 2 Step
$48
$14 each
Rubella Titer (German Measles)
$20
Rubeola Titer (Measles)
$18
Varicella Titer (Chicken Pox)
$20
Mumps Titer
$20
Tetanus/Diphtheria/Pertussis vaccination (TDAP)
$63
Hepatitis B Titer
$20
Drug Test – This test MUST be done through
castlebranch.com
$32
10 Panel: Marijuana, Cocaine, Phencyclidine,
Amphetamines/Methamphetamines, Opiates, Barbiturates,
Benzodiazepines, Methadone, Methaqualone & Propoxyphene.
(See Page 12 for details and appropriate package codes)
Flu Vaccine –
*
Proof of vaccination 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.
If flu vaccine is not available, students may be required to get vaccine when
it becomes available in the Fall.
*Pricing varies by Clinic and season
Chart Review
Health Requirements
Updated 04/12/16
$30
Service MUST be done by Edward Corporate Health.
Page 3
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
$35
Service MUST completed through CastleBranch; The above records will be
managed through CastleBranch creating a personal profile that students
will have unlimited access to beyond graduation. Click here for Medical
Document Manager Student Video Link:
Getting Started with CastleBranch
(See Page 12 for details and appropriate package codes)
Background Check – This MUST be
completed through CastleBranch
$46
This MUST be completed through CastleBranch.
(*With the exception of Dental Hygiene students)
(See Page 12 for details and appropriate package codes)
Total
Possible additional services offered (pending
titer or TB results)
MMR Vaccine (per dose)
(Measles/Mumps/Rubella) 2 shots needed if
lack of immunity to Measles (rubeola) or
Mumps. One shot if not immune to Rubella
$380*
$75
Varicella Vaccine (per dose) – need two
shots if no immunity
$105
Hepatitis B Vaccine 1
$48
Hepatitis B Vaccine 2
$48
Hepatitis B Vaccine 3
$48
Menningococcal vaccination
$120
Chest X-ray
Health Requirements
Updated 04/12/16
This is an estimate, as services will vary by individual student’s health history
and records. *Prices are subject to change.
$55 –
one view
(Tech and reading) If positive TB two step need two view which is $68
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 04/12/16
Page 5
TO AVOID MULTIPLE TRIPS TO YOUR PROVIDER AND/OR EDWARDS CORPORATE HEALTH,
YOU ARE ENCOURAGED TO COME TO AN ADVISING SESSION PRIOR TO STARTING HEALTH
REQUIREMENTS.
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
Medical History
_______
_______
_______
WHAT
Confidential Medical History form to be To provide health care
completed by YOU!
provider with an
overview of your
medical history.
Physical Examination Report A summary of the physical exam
performed by your primary care
provider (i.e. MD, NP) using the form
attached
MMR

Measles (Rubeola)

Mumps

Rubella
1.
Varicella - Chicken Pox
Hepatitis B
WHY
2.
ADDITIONAL INFORMATION
Complete and take with you for your Physical
Examination
To insure you can
Equal to a school or sports physical; must be done
perform the role of the within 12 months of starting the program
profession you are
preparing for.
To insure your ability to If Rubeola, Mumps or Varicella titers are NEGATIVE or
Authentic Documentation of “fight” communicable EQUIVOCAL the student must receive the vaccination
vaccination history,
disease and/or prevent series.
the spread of it.
This is a series of two (2) vaccinations that must be
OR
given 4-6 weeks apart. These vaccines are LIVE. They
can be given at the same time, however if they are not
Documented titer levels
they need to be 4 weeks apart.
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).
If Rubella titer is NEGATIVE or EQUIVOCAL the student
must have a single vaccination.
Note: If you have a negative titer - TB tests must be
done prior to giving a live vaccine. Reason: If the MMR
is given prior to the second TB test, it may read as a
false negative. The TB test must then be given 4-6
weeks after the MMR/Varicella vaccines. Therefore,
please plan these vaccinations accordingly & make sure
that each student can get all their tests done.
Students may go to clinical site if they have received
one of the two live vaccines needed. Students must
complete their series of live vaccines within 4-6 weeks.
Students will need to show proof of second vaccine.
Students will not be able to continue in clinical rotations
unless the vaccine series is completed.
_______
Two-Step TB test or
Equivalent
Health Requirements
Updated 04/12/16
A series of two subcutaneous
Proof that you are free
injections; takes approximately 10 days of Tuberculosis
to complete the two injections and the
reading of them.
Procedure:
1. Administer Tuberculin skin test
2. Read the reaction 48-72 hours later
3. If first test is positive, consider the
person infected
4. If first test is negative, give second
test. This should be a week after the
first skin test
5. Read second test 48-72 hours after
injection
6. Measure only induration, Record
reaction in millimeters only
Must be within 3 months of starting the class/clinical.
If TB test is POSITVE, chest x-ray or QuantiFERON®-TB
Gold test (QFT-G) is required. NOTE: Chest X-ray needed
ONLY if skin test is positive. Chest X-ray & QuantiFERON
Gold Test must be within 90 days of the clinical start.
Note: If a student is currently a health care worker and
complies with his/her employer’s TB testing policy, it is
possible that a student may only need a one step or
possibly not need any TB testing depending on date of
current TB test (proof from student is required).
Page 6
Hepatitis B vaccination
_______
_______
_______
Diphtheria, Tetanus, and
Vaccination is given and covers three
Pertussis – Tdap vaccination diseases.
Gain immunity to
Current medical advice indicates that this is a
Diphtheria, Tetanus and necessary vaccination to protect students entering a
Pertussis
health care facility from noted diseases.
Drug Test
MUST be done through
CastleBranch
A urine test for presence of identified
drugs. The drug test must be a 10
panel.
Proof of being drug free Must be administered within 90 days or less prior to
the students first day of class or clinical. (Refer to
specific program instructions and Final Page for
appropriate Package Code and further details).
Flu Vaccine
Vaccine given annually
NOTE: The flu vaccine is seasonal and
changes every year in the Fall.
Minimize risks of
acquiring the flu
_______
Proof of vaccination MUST
include the following:
(1) Student name
(2) Clinic name
(3) Clinic address
(4) Date administered
(5) Lot# of vaccine.
Must have proof of flu vaccine for current flu season.
Can be waived for documented allergy or religious
reasons only.
Proof of vaccination MUST include the following:
(1) Student name
(2) Clinic name
(3) Clinic address
(4) Date administered
(5) Lot# of vaccine.
Chart Review
All medical records must be reviewed Medical personnel are
by Edward Corporate Health. A
reviewing student’s
clearance form will be given to you. You medical records
will then upload the document through
CastleBranch.
Background Check
Must be done through
CastleBranch*
Background Checks are completed
through CastleBranch.
_______
_______
Three vaccination series administered Gain immunity to
over a 6 month time period or longer to Hepatitis B
develop an immune status to Hepatitis
B.
Medical Document Manager Once all of the above requirements are Your medical documents
(submission of Health
complete, ALL Medical Documents must will be maintained in a
Records)
be uploaded to CastleBranch once the secure web-based
Chart Review is complete.
management system.
*Excludes Central Sterile
Processing (SURGT 1111)
students
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. Recommendation is to begin the
process 2-3 months prior to first day of class or clinical.
Refer to Page 12 for appropriate Package Code and
further details.
(*With the exception of Dental Hygiene students)
Students will have unlimited access to their Medical
Documents through graduation and beyond.
(Refer to Page 12 for appropriate Package Code and
further details)
*Central Sterile Processing (SURGT 1111) students will
NOT be ordering the Medical Document Manager.
CPR Card
Must be American Heart Association –
Health Care Provider. Card must be
signed by student.
Medical Insurance
Can be purchased through the college Required by clinical sites Must be valid through entire length of chosen program
(University Health Plans or Integrity
Insurance and Financial is the insurer)
for a semester at a time. Please visit
Center For Access and
Accommodations website for details.
Health Requirements
Updated 04/12/16
Expiration date must be after completion date of
chosen program.
Page 7
CONFIDENTIAL MEDICAL HISTORY
FOR
COLLEGE OF DUPAGE
425 FAWELL BLVD., GLEN ELLYN, ILLINOIS 60137
To be completed by student
Please Print
Name ___________________________________________________________________________
Last
First
Middle
Allied Health Program ______________Date of Birth _______________SS# ___________________
Address _________________________________________________________________________
City
State
Zip
Phone
Person to notify in an emergency _______________________________Phone _________________
Relationship ______________________________________________________________________
Medications you are currently taking:
Medication
________________________
________________________
________________________
Dose
__________
__________
__________
Frequency
_____________
_____________
_____________
Have you had these diseases?
Rubella
Yes
No
Rubeola
Yes
No
Epilepsy
Yes
No
Hepatitis
Yes
No
Reason
____________
____________
____________
Do you presently have:
Asthma
Yes
Heart Disease
Yes
Colitis
Yes
Diabetes
Yes
Are you aware of health risk issues? (i.e. smoking, drinking, drug use, safe sex):
Yes
No
Do you want to discuss the above health risks with the Doctor?
Yes
No
Females: Do you receive yearly PAP/Breast exam?
Yes
No
No
No
No
No
Are there any other conditions of which Health Service should be aware? If yes, please explain:
__________________________________________________________________________________________________________________
______________________________________________________
Can you perform all the functions required of a student assigned to a participating health care setting at an affiliating institution with or
without accommodation?
Yes
No
If you require accommodation, please explain: _____________________________________________
___________________________________________________________________________________
When was your last:
Physical examination ____________ Tetanus Booster_____________ Chest X-ray or TB skin test ____
I am aware of the physical requirements of my professional program and certify that the above medical history is current and accurate. I
further understand that any false answer or statements made by me in this application, or any supplement thereto, will be grounds for
immediate dismissal from classes/program.
Name____________________________________________________ Date______________________
Health Requirements
Updated 04/12/16
Page 8
PHYSICAL EXAMINATION REPORT
COLLEGE OF DUPAGE
425 FAWELL BLVD., GLEN ELLYN, ILLINOIS 60137
Please Print
Name ________________________________________________________________________________________
Last
First
Allied 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 04/12/16
Page 9
TITER / VACCINE RECORD
COLLEGE OF DUPAGE
425 FAWELL BLVD., GLEN ELLYN, ILLINOIS 60137
Please Print
Name
________________________________________________________________________________________________
Last
First
Allied Health Program ___________________________ Date of Birth _________________SS# _____________________
FOR REQUIRED TITER – ATTACH RELATED LABORATORY REPORTS
TITER
(must be IgC)
Date Blood
Drawn
Rubella
Rubeola
Varicella
Mumps
HbsAb
ADULT VACCINATION RECORD
Date
Manufacturer
Name
Lot #
Administered by
VIS*Date
Diphtheria,
Tetanus, and
Pertussis- Tdap
Hep B#1
Hep B#2
Hep B#3
MMR
Varicella
Previous Hepatitis B series? __________
If documentation unavailable, please explain:
_________________________________________________________________________
_________________________________________________________________________
Positive TB test? Yes ___________ No
___________
Date:
___________________
Two Step TB test
Step 1
Step 2
Date Given: ___________
Date Read: ____________
Date Given: ___________
Date Read: ____________
R/L Time
Results ________mm
R/L Time
Results ________mm
Nurse
Nurse
Nurse
Nurse
Positive TB Test Referred for X-ray to: __________________________________________________________________________
Report following positive TB attached: Date: _________________ Facility: ________________________
TB test update by (MM/DD/YYYY): ____________________
Stamp of Provider of this information
(Name, Address, Phone)
Health Requirements
Updated 04/12/16
Page 10
Edward Hospital
801 S. Washington St.
Naperville, IL 60540
EDWARD CORPORATE HEALTH CLEARANCE FORM
********Form is filled out by Edward Corporate Health- NOT STUDENT********
College of DuPage Program Name: __________________ Semester Clinicals begin: ______________
Be advised that: LAST NAME: ___________________FIRST NAME: _______________ was in our office: ________
(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 Immunity (status):
Hep B series (note dates)
o
Vaccine #1 _______
o
Vaccine #2 _______
o
Vaccine #3 _______
o
Clinic Name:____________________________
OR
o
Clinic Address: (if given at ECH say “see above”)
__________________________________
Titer Date: _________ Result: __________
___________________________________
□ Varicella Vaccine (note dates)
o
Vaccine #1 ______________
Vaccine #2 ______________
Lot #: ______________________________
□ Flu declination (Doctor’s note documenting allergy or letter from Religious clergy
MUST accompany this form, otherwise student cannot decline the flu vaccine).
□ TB Skin Test (must be done within 90 days of clinical start)
□ 2-Step or 1-Step TB Skin Test Given Date:
#1 Date: _____________ Reading _______mm
#2 Date:_____________ Reading _______mm
Expires (1 year) Date: __________
□
QuantiFERON Gold test: Date: __________
(Must be completed within 90 days of clinical start)
Result:_________ Expires: ___________
OR
Titer date:___________ Result:__________
□ Color Vision:
Pass: (circle) Yes OR No
□ Tdap Date: _________________________
□
□ Chest X-Ray
Date:________________
(Must be completed within 90 days of clinical start)
Result:_______ Expires: ___________
□ Annual TB Questionnaire
MMR (note dates)
Vaccine #1 ______________
Vaccine #2 ______________
OR
Titer date: __________ Result: __________
Date:___________
□
“Negative” Chest X-Ray in past? (circle) Yes OR No
Date of “Negative” Chest X-Ray: _____________
Recommendations: If you have any questions or concerns, please feel free to call Edward Corporate Health at (630) 961-4948.
1.
2.
3.
4.
Has been medically cleared by the examining physician to perform the job duties without physical restrictions.
Records have been reviewed. Based on submitted information is cleared to perform job duties without physical restrictions.
Cleared with the following restriction (Restrictions may prevent acceptance into program.
____________________________________________________________________________________________________
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
Health Requirements
Updated 04/12/16
_______________________
Date
Page 11
Student Instructions: Background Check, Drug Screen & Medical Document Manager
MyCB (previously CertifiedProfile) 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 MyCB,
including document storage, portfolio builders and reference tools. MyCB also allows you to upload any additional documents
required by your school.
Place Your Order:
1. Go to: www.CastleBranch.com and enter the appropriate package code from the list below.
2. You will then be directed to set up your MyCB account. (Reference pages 3-4 for pricing).
3. Getting Started with CastleBranch.
4. Please visit the Medical Document Manager Student Video Link for detailed instructions:
http://video.certifiedbackground.com.s3.amazonaws.com/meddocmgr.html
Program
Anesthesia Technology
Cardiac Interventional Radiography
Central Sterile Processing (SURGT 1111)
Computed Tomography
Dental Hygiene
EMT & Paramedic (Background Check)
EMT & Paramedic (Drug Test)
Health Information Tech
Hearing Instrument Dispensary
Mammography
Medic to PN
Medical Assistant
Magnetic Resonance Imaging
Nuclear Medicine
Perioperative Nursing
Phlebotomy/EKG
Physical Therapist Assist.
Polysomnography
Proton Therapy
Radiation Therapy
Radiography
Respiratory Care
Sonography
Speech Language Pathology
Surgical Assisting
Surgical Tech Program (NOT for Central
Processing (SURGT 1111 students)
Health Requirements
Updated 04/12/16
Code
OE04
CW62
CL88
CY62
CY63
CB39
CB39dt
OG19
TBD
OE55
OD99
CY65
OE77
OL85
CY61
CY60bg & CY60dt
CE06
CY86
CY85
CC91
OE45
CN76B
OL86
OL15
OE30
CY94
Type of Package
Background Check, Drug Test & Medical Doc. Manager
Background Check, Drug Test & Medical Doc. Manager
Background Check & Drug Test ONLY
Background Check, Drug Test & Medical Doc. Manager
Drug Test ONLY & Medical Doc. Manager
Background Check
Drug Test
Background Check, Drug Test & Medical Doc. Manager
Background Check, Drug Test & Medical Doc. Manager
Drug Test and Background Check
Background Check, Drug Test & Medical Doc. Manager
Background Check, Drug Test & Medical Doc. Manager
Background Check, Drug Test & Medical Doc. Manager
Background Check, Drug Test & Medical Doc. Manager
Background Check and Drug Test ONLY
Background Check, Drug Test & Medical Doc. Manager
Background Check, Drug Test & Medical Doc. Manager
Background Check, Drug Test & Medical Doc. Manager
Background Check, Drug Test & Medical Doc. Manager
Background Check, Drug Test & Medical Doc. Manager
Background Check, Drug Test & Medical Doc. Manager
Background Check, Drug Test & Medical Doc. Manager
Background Check, Drug Test & Medical Doc. Manager
Background Check, Drug Test & Medical Doc. Manager
Background Check, Drug Test & Medical Doc. Manager
Page 12