CLINICAL CLEARANCE PROCESS
In 2012, SON began using Certified Background Check (https://www.certifiedbackground.com/)
(also known as “Certified Profile”) to centralize the required documents for clinical classes. You
are able to create a profile for multiple instructors to review, thereby decreasing duplication of
efforts and documentation.
For students who have started a clinical course prior to summer 2014—
You already purchased the Certified Background Check (CBC) packet and submitted required
documents. You need to:
1. Update the health-related documents that are expired.
2. Upload the Learning Contract with Course Objectives form provided by SON
(http://www4.csudh.edu/son/forms/index). Each course has its specific Learning Contract
with Course Objectives Form (BSN 411, BSN 421, and BSN 451). You need to discuss
with the preceptor and fill out page 1 and the “Learning Activities” and “Evaluation
Measures” columns before you upload the document to the “Learning Contract with
Course Objectives” box.
3. For BSN 451, you also need to upload the preceptor resume/CV in the “Preceptor
Documents” box.
4. You can upload more than one document at a time. The embedded document below
provides you with instructions.
How to Upload
Documents to CBC.doc
NOTE: The instructor will review the learning contract/objectives and preceptor’s CV (for BSN
451). Most instructors do this within 1-2 weeks of the semester. You can check back in the CBC
website again during the first week to see if you are cleared. If not, you can contact the instructor
to seek guidance. Do remember, you cannot start your clinical until you are approved by the
instructor (who has the final say). If you start collecting the hours without the instructor’s
approval, you may automatically be failed from the course.
Other forms you may need in your clinical course are listed below. These forms are NOT
submitted to the CBC.
1. Clinical Hours-Activity Tracking Log-- You need to submit the complete log via the
Blackboard.
2. Midpoint Progress Note – Check on the Blackboard or check with your instructor at the
first week of the semester.
3. Preceptor Assessment of Student Progress Form -- The preceptor will mail or email
the instructor the completed, signed form at the end of your clinical.
4. Student Evaluation of Preceptor Form—You need to complete and submit this form to
the Blackboard (under Assignment Link) once you complete the clinical hours.
You can access to these forms on the SON website at http://www4.csudh.edu/son/forms/index
For students who will start a clinical course later than summer 2014 —
A. Clinical Clearance Documents- Start submitting these documents two months
before the semester starts.
VACCINATIONS:
1. Measles, Mumps & Rubella (MMR) –
a. There must be documentation of ONE of the following:
i. Two doses of MMR
ii. Laboratory confirmation of disease or immunity. Positive antibody titer for Measles,
Mumps & Rubella. IgG’s results must be reported.
1. If you have received two doses of MMR and report an equivocal or negative
titer, there is no need to repeat the vaccine.
2. If you have NOT received two doses of MMR and report an equivocal or
negative titer, you MUST receive two doses of MMR, 28 days apart. No
follow up titer is needed.
2. Varicella (Chicken Pox) –
a. There must be documentation of ONE of the following:
i. Two doses of Varicella Vaccine.
ii. Laboratory confirmation of disease or immunity. Positive antibody titer (lab report
required) for Varicella. IgG results must be reported.
1. If you report an equivocal or negative titer, you MUST receive two doses of
Varicella, 4-6 weeks apart. No follow up titer is needed.
3. Hepatitis B –
a. There must be documentation of ONE of the following:
i. Three dose Hepatitis B series WITH Positive antibody titers. Typically scheduled 1-2
months after dose #3. Hep B AB (antibody) titers must be reported.
1. If titer is negative, you should complete another 3 dose series, with titer
drawn 1-2 months after dose #3.
a. If titer remains negative, you are considered a non-responder. No
further testing needed.
ii. Signed declination waiver
4. Tetanus, Diphtheria & Pertussis (Tdap)
a. There must be documentation of ONE of the following:
i. Tdap within last 10 years.
ii. One time vaccination of Tdap (at any point) AND Td booster within the last 10 years.
5. Influenza:
a. There must be documentation of the following:
i. One dose of influenza vaccine annually.
Center of Disease Control and Prevention, (2011). Immunization of Health-Care Personnel: Recommendations of the
Advisory Committee on immunization practices. Retrieved from http://www.cdc.gov/mmwr/pdf/rr/rr6007.pdf
Immunization Action Coalition. (2014). Healthcare worker immunization requirements. Retrieved from
http://www.immunize.org/catg.d/p2017.pdf
TB Skin test (TST):
There must be documentation of ONE of the following:

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
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1 step TB Skin Test (TST) or if required by your clinical site, 2 step TST (1-3 weeks
apart).
2 consecutive annual TSTs (no more than 12 months between tests AND at least one
being within the last 12 months).
TB blood test (QuantiFeron Gold Test or T-spot).
If the results are positive, a clear Chest X-Ray (with lab report) PLUS documentation
from your provider that you are free of TB.
A repeated chest x-ray is not needed, unless required by the agency. Only
documentation from a provider stating that you are screened and free of TB is to be
submitted every year.
CPR Certification:
There must be the American Heart Association Healthcare Provider course for Basic Life
Support (BLS). Copy must be front and back of the card, it has to be signed. Certificates issued
in accordance with AHA Curriculum are acceptable.
HIPAA Certification:
Submit certification of completion from an employer OR http://www4.csudh.edu/son/info/hipaaprecautions/index
Universal Precautions and Blood Borne Pathogens:
Submit certification of completion from an employer OR http://www4.csudh.edu/son/info/hipaaprecautions/index
RN License:
Submit verification of RN licensure through the state website
http://www.rn.ca.gov/online_services/perm-verif.shtml
Learning Contract with Course Objectives:
1. The Learning Contract with Course Objectives form provided by SON can be found at
http://www4.csudh.edu/son/forms/index. Each course has its specific Learning Contract
with Course Objectives Form (BSN 411, BSN 421, and BSN 451).
2. You need to discuss with the preceptor and fill out page 1 and the “Learning Activities”
and “Evaluation Measures” columns before you upload the form to CBC. Meeting with
the preceptor to create a proposed learning contract is NOT counted towards clinical
hours.
3. If the Learning Contract with Course Objectives form is initially reviewed and signed by
the clinical coordinator or main preceptor, you must discuss and share your learning
contract with each designated preceptor.
Preceptor Resume or CV:
1. BSN 411 and 421 -- You do not need to submit the Preceptor Resume or CV.
2. BSN 451 -- You need to submit the Preceptor Resume or CV to Certified Background
Check.
B. Certified Background Check (CBC)
Ordering:
You will submit the CSUDH required clinical documents (above) and additional
requirements specified by the clinical agency via a secure online service
CertifiedBackground.com. Various packages have been set up for the student to purchase only
the components that are needed. All students must order the Document Tracker and Professional
License Verification (CQ90im). The Document Tracker will remain available to you throughout
the entire program without additional cost.
If the clinical agency requires a background check and/or drug screen, those items must also
be ordered. San Diego area students should contact their preceptor prior to ordering because a
different system is used by hospitals in that area.
Package
Document tracker and Professional License Verification ($43)
Background Check only ($43, optional)
BSN
CQ90im
CQ90bg
Drug Test only ($35, optional)
Professional License Verification only (for license renewal, $8, optional))
CQ90dt
CQ90L
Procedure:
1. Go to www.certifiedbackground.com
2. In the Place Your Order area of the website, insert the appropriate package code. You
will be directed to set up a Certified Profile account. 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. Use the same name (first name, middle initial,
last name) and email address in all packages you order. However, be sure to inform your
instructor if the last name you are using in Certified Background is different from the last
name that is listed on the course roster.
3. 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.
4. If a drug test was ordered, within 24-48 hours, an electronic chain of custody form
(echain) will be placed directly into your Certified Profile account. This echain will
explain where you need to go to complete your drug test (LabCorp sites).
5. Once you know which courses you'll be enrolled, you'll need to order the corresponding
course document manager. This is where the clinical agency is listed and the completed
Learning Contract is posted. To place a new order once you're logged into your profile,
just click on the “Place Order” button located on the top right side of the screen. Use the
same name (first name, middle initial, last name) and email address in all packages you
order. You'll then be asked to type in your package code. There is no additional cost on
this order. Based on which course you’re taking type in one of the three package codes:
If you are enrolled in BSN 411 use the code: CQ90bsn411
If you are enrolled in BSN 421 use the code: CQ90bsn421
If you are enrolled in BSN 451 use the code: CQ90bsn451
6. Read the “How to Upload Documents to CBC” file. Click on the embedded file below.
NOTE: You can upload more than one document at the same time.
How to Upload
Documents to CBC.doc
7. Upload all required documents (e.g., vaccination/TST record, HIPAA, Universal
Precaution, CPR certificate, RN license verification). Faxing the document is another
alternative as noted in the "How to Upload Documents to CBC" file above. One more
alternative- Depending on your scanner, when a document is scanned, each page may be
saved as a separate file. Full version of Adobe acrobat could merge files. But if you do
not have an access to one, you may print all documents. Then, you scan them and save in
Jpeg format as pictures. Then, you post the pictures into one MS word file, and convert it
to pdf. However, the major issue is the loss of quality of the document.
8. In the “clinical affiliation site” box, type the clinical site name. Don't abbreviate. Also,
include the current status of your site contract by indicating one of these following
conditions:
 Active contract
 Expired contract but a renewal request has been made
 New site- request for the affiliation agreement initiation has been made.
Should you need to update the clinical site information (e.g., the contract cannot be established,
the preceptor is no longer available), you can request the CBC to “reset” the item and then enter
in the new site information.
Results:
Your results will be posted directly to your Certified Profile account and will be reviewed by the
Certified Profile staff. 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 “Pending” until it has
been completed in its entirety. You will receive periodic reminders of overdue items, rejected
items, and items that are due for renewal. When a document has been approved the word
“Complete” will be next to it.
There are 3 possible results of your clearance submission:
 Complete—> you are good to go.
 Rejected--> you need to upload new files that will satisfy the requirement.
 Pending  you need to wait. However, if you inadvertently submit an incorrect
document, you can ask CBC representative to clear the document so that you can resubmit.
CSUDH advisors and instructors can also securely view your results online with their unique
username and password. You do NOT need to share your file with the instructor. If requested by
the agency, the “share” function could be used for your potential employers to give them access
to your information on the Certified Background Check website.
NOTE: The instructor will review the learning contract/objectives and preceptor’s CV (for BSN
451). Most instructors do this within 1-2 weeks of the semester. You can check back in the CBC
website again during the first week to see if you are cleared. If not, you can contact the instructor
to seek guidance. Do remember, you cannot start your clinical until you are approved by the
instructor (who has the final say). If you start collecting the hours without the instructor’s
approval, you may automatically be failed from the course.
Need Help?
If you need assistance please contact CertifiedProfile at 888-914-7279 or
cpservicedesk@certifiedprofile.com and a Student Support Representative will be available
Monday-Thursday 8am-8pm, Friday 8am-8pm & Sunday 10am-6:30pm EST.
C. Other Clinical Forms
Other forms you may need in your clinical course are listed below. These forms are NOT
submitted to the CBC.
1. Clinical Hours-Activity Tracking Log-- You need to submit the complete log via the
Blackboard.
2. Midpoint Progress Note – Check on the Blackboard or check with your instructor at the
first week of the semester.
3. Preceptor Assessment of Student Progress Form- The preceptor will mail or email the
instructor the completed, signed form at the end of your clinical.
4. Student Evaluation of Preceptor Form—You need to complete and submit this form to
the Blackboard (under Assignment Link) once you complete the clinical hours.
You can access to these forms on the SON website at http://www4.csudh.edu/son/forms/index