University of North Florida
Doctor of Physical Therapy Program
Requirements for Clinical Education
Name: ___________________________________
Updates
Needed
One-time
documentation
Date
Completed
__/__/___
Lab Report from Healthcare Provider
One-time
documentation
__/__/___
Training at
http://privacy.health.ufl.edu/training/visitors/ins
tructions.shtml
Documentation from Healthcare Provider
One-time
documentation
of training
One-time
documentation
Annually
__/__/___
Annually
__/__/___
Annually
__/__/___
Tb Test
(Annually)
Chest X-ray
(Every 3years)
Annually
documentation,
must remain
current
Annually or
every two
years
(depending on
provider)
Annually
__/__/___
Every 10 years
__/__/___
Requirement
Varicella
Immunity Titer
Appropriate Documentation
Lab Report from Healthcare Provider
Hepatitis B
Antibody Titer
HIPAA Training
MMR (Measles ,
Mumps, Rubella)
Criminal
www.certifiedbackground.com website
Background
Check-Level 2
Criminal
www.certifiedbackground.com website
Background
Check-Level 1
Drug Screen
www.certifiedbackground.com website
Tb Skin Test (or
Chest X-ray if
positive skin
test)
Health Insurance
Documentation from Healthcare Provider
Healthcare
Provider BLS
Copy of current certification card
Physical Exam
“UNF Student Health Exam” form completed
by healthcare provider
Tetanus
Documentation from Healthcare Provider
Download copy of current insurance card
reflecting your name (or letter)
__/__/___
__/__/___
__/__/___
__/__/___
__/__/___
Important: Student should keep the original of all healthcare information in a secure place for
any future access that might be needed, in addition to uploading the required forms to Medical
Document Manager.
Revised August 2014