College of Nursing Immunization Requirements:
The required vaccinations for all College of Nursing programs are listed below. Please submit this
form directly to Student Health Services once the entire form is completed by your primary care
provider. Once Student Health Services processes your records, you can monitor your
compliance status through the College of Nursing Beacon Portal.
Submission Instructions:
• Once this form is completely filled out by your health care provider, this form and all
required supporting documentation must be uploaded through My BuckMD. Vaccination
records should not be submitted to the Office of Student Affairs and Success through
• All medical documentation for compliance should be submitted at once utilizing this form,
with the exception of those students who are being revaccinated for Hepatitis B.
• This form will be kept in your medical record at Student Health Services. Student Health
Services will exchange health information with your academic program only for the purposes
of determining compliance with program requirements under the Family Educational Rights
and Privacy Act (FERPA).
• If you have any questions regarding specific immunization requirements, please contact the
• Please allow Student Health Services 1-2 weeks for the processing of records. During times
of high submission volume, this processing time may be even longer. Be sure to submit your
documentation early enough ahead of any deadlines to remain compliant. You will receive a
confirmation message from SHS once the document is processed.
• Non-health related compliance requirements submitted to Student Health Services will not
be processed and will be deleted/shredded for security.
Please see the following pages for additional information regarding the various immunization and
testing requirement for the College of Nursing.
Immunization and Testing Requirements
1. Hepatitis B: a complete vaccination series (either 2-dose or 3-dose) AND a positive surface antibody titer required.
• If you have documented proof of a complete hepatitis B vaccination series, a titer must be collected to
determine your antibody levels and immunity.
o Positive results mean you are immune, and no additional vaccines or testing are required.
o Negative results will require re-vaccination to raise your antibody levels, with a repeated titer required
afterwards to check your immunity from the new vaccine(s).
Re-vaccination option 1: receive a booster dose of the Hepatitis B vaccine, then re-titer one
month after vaccine administration.
Re-vaccination option 2: repeat entire 2-dose (HEPLISAV-B) or 3-dose vaccine series, then
re-titer one month after the last dose.
• If there is no documented proof of a complete hepatitis B vaccination series, a new series must be completed
before a titer is collected. Positive hepatitis B surface antibody titers without proof of a complete vaccination
series will not be accepted.
2. Influenza: a current and updated influenza vaccine required annually.
• The new flu vaccines are usually available starting in late August/early September each year.
3. MMR: a complete 2-dose vaccine series required.
• 2 doses of the MMR vaccine given after 1 year of age is acceptable for the requirement.
• Measles, mumps, and rubella titers are only recommended if there is no proof of the vaccination history, but
the student is certain they received the vaccines in the past.
o Positive results mean you are immune, and no additional vaccines or testing are required.
o Negative titer results will require re-vaccination, with no repeated titers required.
4. Tdap: one Tdap vaccine within the last 10 years required.
• If Tdap vaccine is over 10 years old and expired, a TD or Tdap booster dose is required.
5. Toxicology (drug) screen: a negative 10-panel urine drug screen required upon entry to the program.
• Results must show number of total drugs tested and overall/individual results with the date included.
6. Tuberculosis: initial negative 2-step PPD or QFT-G blood test; annual BuckeyeLearn training module required.
• For the first year of the program, students are required to have an initial negative 2-step Tuberculosis skin test
(PPD), which is two separate PPDs completed within 1-3 weeks of each other.
• One negative TB blood test (QFT-G, T-Spot, or IGRA) will satisfy the 2-step PPD requirement.
• In following years, the Infection Prevention Starts With You eLearning module on BuckeyeLearn must be
completed to remain compliant – annual testing is only required for clinicals with a high risk of TB exposure.
7. Varicella: a complete 2-dose vaccine series required
• 2 doses of the Varicella vaccine given after 1 year of age is acceptable for the requirement.
• If a student never received the vaccines because of having Chickenpox in the past, a Varicella antibody titer is
required to prove immunity from having the disease.
8. COVID-19: approved vaccination or approved medical/religious exemption required.
• Acceptable vaccines: either the primary vaccine or series (original Pfizer 2-dose, Moderna 2-dose, or Janssen
1-dose) OR 1 dose of the most current COVID-19 monovalent vaccine (Pfizer, Moderna, Novavax).
• For exemptions requests, please visit the CON immunization website for a copy of the required form.
.
.
Requirement Required Documentation
Hepatitis B
A full vaccine series
AND
a positive surface
antibody titer
required
Note: a positive titer
without proof of a full
vaccine series will
not be accepted
3 dose series
(Engerix-B, Recombivax HB, Twinrix)
Dose #1 date: ________________
Dose #2 date: ________________
Dose #3 date: ________________
2-dose series
(HEPLISAV-B)
Dose #1 date: ________________
Dose #2 date: ________________
Provider initials: ______________
Hepatitis B surface antibody
titer (HBsAb)
Date Completed: ______________ Result: _______________
.
Lab report attached
If the titer is negative, either a booster dose or a full series (either 2-dose or 3-dose) must be completed,
with a repeated titer completed 4 weeks afterwards.
MMR
(Measles, Mumps,
Rubella)
2 doses of the MMR
vaccine required
MMR #1 date: ___________________
MMR #2 date: ___________________
Provider initials: ______________
**MMR titers only required if proof of vaccination is unable to be located**
Positive Measles, Mumps, and Rubella antibody titers: Lab report attached .
Tdap
(Tetanus, Diphtheria,
Pertussis)
Date: _______________________
**SELECT ONE**
Adacel or Boostrix
Provider initials: ______________
Tdap must be re-administered every 10 years (TD booster acceptable after initial Tdap vaccine)
Varicella
(Chickenpox)
2 doses of the
Varicella vaccine
required
Varicella #1 date: ___________________
Varicella #2 date: ___________________
Provider initials: _____________
**Varicella titer only required if previously infected with the disease (Chickenpox) or
if proof of vaccination is unable to be located**
Positive Varicella antibody titer: Lab report attached .
(Continued on next page)
**All dates of service for vaccines and testing must be before the date of the provider signature** 2024-2025
Full Name: ________________________________ Date of Birth: ____________ Academic Program: __________________
OR
Requirement Required Documentation
Tuberculosis
Screening
First year ONLY:
Either a 2-step PPD
OR
TB blood test
required
Returning Students:
Completion of the
Infection Prevention
Starts With You
eLearning module on
BuckeyeLearn
required (submit
certificate to My
BuckMD separately)
2-step tuberculin skin test
PPD testing must meet the
following criteria:
• Must be read in 48-72 hours by
a certified health care provider
with results documented in mm.
• 2
nd
PPD must be placed 1-3
weeks after the placement date
of the first.
PPD #1 given: _______________
PPD #1 read: ________________
Result: _________________ mm.
Read by: ____________________
Title: _______________________
PPD #2 given: _______________
PPD #2 read: ________________
Result: _________________ mm.
Read by: ____________________
Title: _______________________
TB blood test (IGRA)
Recommended for those that have
received the BCG vaccine
Date Completed: ____________ Result: _______________
Type of Test: _______________ Lab report attached
Positive TB tests (either past or current) will require the completion of a one-time chest x-ray and annual
Tuberculosis questionnaire. Please consult the Preventive Medicine department at Student Health Services to
discuss appropriate next steps for the compliance requirement
Drug Screen
10-panel urine test
Completion Date: _________________ Results:____________________ Lab report attached
Influenza
2024-2025 vaccine
Dose date: ___________________
Provider initials: ______________
NOTE: Vaccine does NOT automatically transfer from OSUWMC or Employee Health flu blitzes
UPLOAD YOUR COVID-19 VACCINE CARD SEPARATELY FROM THIS FORM
Provider
Information
MD, DO, CNP,
PA, RN
signature required for
this document to be
valid
Name/Credentials: _________________________________________________________________
Address: _________________________________________________________________________
________________________________________________________________________
Phone: _________________________________________________________________________
Signature: ______________________________________________ Date Completed: __________________
**All dates of service for vaccines and testing must be before the date of the provider signature** 2024-2025
Full Name: ________________________________ Date of Birth: ____________ Academic Program: __________________
OR
.
Hepatitis B Revaccination
Only complete this page if your initial Hepatitis B surface antibody titer was negative
Please submit this document as each dose is received so you can remain temporarily compliant throughout the entire revaccination
process. Revaccination should begin as soon as possible after the initial negative titer is returned.
3-dose series
(Engerix-B,
Recombivax HB,
Twinrix)
Single booster dose
or full series
accepted
Repeat titer required
4 weeks after last
dose received
Booster / Dose #1: ____________________
Signature/credentials: _________________________
Location: ___________________________________
Dose #2: ____________________
Signature/credentials: _________________________
Location: ___________________________________
Dose #3: ____________________
Signature/credentials: _________________________
Location: ___________________________________
OR
2-dose series
(HEPLISAV-B)
Single booster dose
or full series
accepted
Repeat titer required
4 weeks after last
dose received
Booster / Dose #1: ____________________
Signature/credentials: _________________________
Location: ___________________________________
Dose #2: ____________________
Signature/credentials: _________________________
Location: ___________________________________
AND
Repeated
Hep B Surface
Antibody Titer
Complete 4-6 weeks
after last dose of the
vaccine
Date Completed: ____________________ Result: ____________________
Supporting documentation for the surface antibody titer is required in order to be accepted
If repeated titer is still negative, please contact the Preventive Medicine department at
Student Health Services for advice on the next steps for compliance.
(END OF DOCUMENT)
2024-2025
Full Name: ________________________________ Date of Birth: ____________ Academic Program: __________________
