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Student and Learner Placement Service Immunization & Infectious Diseases Screening Form

October 8, 2023

Students/Learners must provide their Placing Agency with proof of obtaining all the vaccinations and immunity tests NSH requires.   Placing Agencies may choose to use the form provided to collect vaccination and immunity test records from their students/learners.  Depending on the student/learner’s discipline or placement area, NSH may waive the Hepatitis B vaccination and/or two-step Tuberculosis Skin Test requirement. If unsure of the requirements for your placement, please contact us.

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