EMT & Paramedic
HEALTH REQUIREMENTS
For EMT & Paramedic students
For EMT students, Health Requirements are NOT required PRIOR to Registration but MUST BE COMPLETED by
midterm of the semester. Remember that the final TB read & Drug Screen must be done no earlier than 90 days
prior to clinical start; (ie. for Spring 2016 they need to be completed beginning 12/27/15 or later; for Summer
2016 beginning 3/26/16 or later, and for Fall 2016 they need to be completed beginning 7/18/16 or later).
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.
EMT & Paramedic Health Requirements
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).
1. Go to www.castlebranch.com (NOTE: For Spring 2016 they need to be completed beginning 12/27/15 or later; for
Summer 2016 beginning 3/26/16 or later, and for Fall 2016 they need to be completed beginning 7/18/16 or
later).
2. In the Package Code box, enter package code: CB39dt
3. You will then set up your Certified Profile account.
4. After you place your order for the Drug Test (Quest), you will receive an email directly from the lab containing
your electronic chain or custody form (e-chain) within 24-48 hours. The subject line will read: “Form Fox” and it
will explain where you need to go to complete your drug test.
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 4), 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.
EMT & Paramedic Health Requirements
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.
******Pricing is determined by Edward Corporate Health and is subject to change without notice******
Edward
Hospital
Contact information:
See page 4 for locations and hours of
operation
Notes
Note: Second-year pricing is the same as the first-year required
services.
Services Offered
Physical Examination
TB 2 Step
Rubella Titer (German Measles)
Rubeola Titer (Measles)
Varicella Titer (Chicken Pox)
Mumps Titer
$48
$14 each
$20
$18
$20
$20
Tetanus/Diphtheria/Pertussis vaccination
(TDAP)
$63
Hepatitis B Titer
Drug Test – This test MUST be done through
castlebranch.com and completed by
midterm. (Go to www.castlebranch.com
(previously CertifiedBackground) and
choose Package Code: CB39dt).
$20
$32
Flu Vaccine –
*
NOTE: The flu vaccine is seasonal and
changes every year in the Fall.
Chart Review
Background Check-Complete PRIOR to
Registration
(Go to www.castlebranch.com (previously
CertifiedBackground) and choose Package
Code: CB39)
Total
EMT & Paramedic Health Requirements
04/12/16
$30
$46
$345*
10 Panel: Marijuana, Cocaine, Phencyclidine,
Amphetamines/Methamphetamines, Opiates, Barbiturates,
Benzodiazepines, Methadone, Methaqualone & Propoxyphene.
For Spring 2016 they need to be completed beginning 12/27/15 or
later; for Summer 2016 beginning 3/26/16 or later, and for Fall
2016 they need to be completed beginning 7/18/16 or later).
Proof of vaccination MUST include the following: (1) Student name,
(2) Clinic name, (3) Clinic address (4) Date administered, and
(5) Lot# of vaccine.
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
Service MUST be done by Edward Corporate Health
This MUST be completed through CastleBranch prior to
Registration.
This is an estimate, as services will vary by individual student’s
health history and records. *Prices are subject to change.
Page 3
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.
EMT & Paramedic Health Requirements
04/12/16
Page 4
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 mandated
by the clinical sites***

WHEN
COMPLETED
REQUIREMENT
_______
WHY
Medical History
Confidential Medical History form
to be completed by YOU!
Physical Examination
Report
A summary of the physical exam
performed by your primary care
provider (i.e. MD, NP) using the
form attached
_______
_______
WHAT
MMR

Measles (Rubeola)

Mumps

Rubella
1.
OR
Varicella - Chicken Pox
Hepatitis B
Authentic Documentation of
vaccination history,
2.
ADDITIONAL INFORMATION
To provide health care
provider with an
overview of your
medical history.
To insure you can
perform the role of
the profession you are
preparing for.
Complete and take with you for your Physical
Examination
To insure your ability
to “fight”
communicable
disease and/or
prevent the spread of
it.
If Rubeola, Mumps or Varicella titers are NEGATIVE or
EQUIVOCAL the student must receive the vaccination
series.
Documented 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).
Equal to a school or sports physical; must be done
within 12 months of starting the program
This is a series of two (2) vaccinations that must be
given 4-6 weeks apart. These vaccines are LIVE. They
can be given at the same time, however if they are
not they need to be 4 weeks apart.
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 46 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
EMT & Paramedic Health Requirements
04/12/16
A series of two subcutaneous
injections; takes approximately
10 days 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
Proof that you are
free of Tuberculosis
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 5
Hepatitis B vaccination
_______
_______
_______
Diphtheria, Tetanus, and
Pertussis – Tdap
vaccination
Drug Test
Must Be Done through
CastleBranch
Flu Vaccine
_______
Proof of vaccination MUST
include the following:
(1) Student name
(2) Clinic name
(3) Clinic address
(4) Date administered
(5) Lot# of vaccine.
A urine test for presence of
identified drugs. At a minimum,
the drug test must be a 10 panel.
Vaccine given annually.
NOTE: The flu vaccine is seasonal
and changes every year in the
Fall.
All medical records must be
reviewed by Edward Corporate
Health. A clearance form will be
given to you. You will then upload
the document through
CastleBranch.
Background Check
Must be done through
CastleBranch
Background Checks are
completed through CastleBranch.
EMT & Paramedic Health Requirements
04/12/16
Gain immunity to
Hepatitis B
Gain immunity to
Diphtheria, Tetanus
and Pertussis
Proof of being drug
free
Minimize risks of
acquiring the flu
Current medical advice indicates that this is a
necessary vaccination to protect students entering
a health care facility from noted diseases.
Must be administered within 90 days or less prior to
the students first day of clinical start. This test
MUST be done through CastleBranch.
(Go to www.CastleBranch.com and choose Package
Code: CB39dt).
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
_______
_______
Three vaccination series
administered over a 6 month
time period or longer to develop
an immune status to Hepatitis B.
Vaccination is given and covers
three diseases.
Medical personnel are
reviewing student’s
medical records
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.
Background Check-Complete PRIOR to Registration
(Go to www.castlebranch.com and choose Package
Code: CB39)
Page 6
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______________________
EMT & Paramedic Health Requirements
04/12/16
Page 7
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.
EMT & Paramedic Health Requirements
04/12/16
Page 8
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
Diphtheria,
Tetanus, and
Pertussis- Tdap
Hep B#1
Hep B#2
Hep B#3
MMR
Varicella
Previous Hepatitis B series? __________
Lot #
Administered by
VIS*Date
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)
EMT & Paramedic Health Requirements
04/12/16
Page 9
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: ______________________
o
Clinic Name:____________________________
o
Clinic Address: (if given at ECH say “see above”)
__________________________________
o
□ Hepatitis Immunity (status):
Hep B series initiated (note dates)
o Vaccine #1 _______
o Vaccine #2 _______
o Vaccine #3 _______
OR
Titer Date: ___________ Result: __________
___________________________________
□ Varicella Vaccine (note dates)
Lot #: ______________________________
Vaccine #1 ______________
Vaccine #2 ______________
□ 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: ___________
□ 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
OR
Titer date:___________ Result:__________
□ Color Vision:
Pass: (circle) Yes OR No
□ Tdap Date: _______________
□ MMR (note dates)
Vaccine #1 ______________
Vaccine #2 ______________
OR
Titer date:__________ Result:__________
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.
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.
____________________________________________________________________________________________________
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
1.
2.
3.
EMT & Paramedic Health Requirements
04/12/16
Page 10
Student Instructions: Background Check & Drug Screen
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.
Order Summary
Order Summary
o Required Personal Information
In addition to entering your full name and date of birth, you will be asked for your Social Security Number,
current address, phone number and e-mail address.
o
Drug Test (Quest)
After you place your order, you will receive an email directly from the lab containing your electronic chain
of custody form (echain) within 24-48 hours. The subject line will read: “Form Fox” and it will explain where
you need to go to complete your drug test.
o
Payment Information
At the end of the online order process, you will be prompted to enter your Visa or Mastercard information.
Money orders are also accepted but will result in a $10 fee and an additional turn-around-time.
Place Your Order
Place Your Order
Go to: www.CastleBranch.com and enter package code:
CB39 – Background Check Only
CB39dt – Drug Test Only
You will then be directed to set up your MyCB account.
View Your Results
Your results will be posted directly to your MyCB account. You will be notified if there is any missing information needed in
order to process your order. Although 95% of background check results are completed within 3-5 business days, some
results may take longer. Your order will show as “In Process” until it has been completed in its entirety. Your school's
administrator can also securely view your results online with their unique username and password. If you have any
additional questions, please contact MyCB at 888-914-7279 or email customerservice@castlebranch.com.
EMT & Paramedic Health Requirements
04/12/16
Page 11