Note: The Medical Records Packet for Clinicals is different than the registration packet you completed for the Student Health Center at the time you enrolled.

Please follow these instructions for completing the Medical Records Packet for Clinicals (pdf).

Page 1 – Introduction

Important things to note:

  1. We will not make copies of any of the documents required for your medical records packet, once they have been placed in your file.
  2. We will scan and email you a complete packet except for the drug test which won’t be done yet and does not get turned in to us.
  3. We use what is called an “Estoppel Status” in our program. You will receive an estoppel letter if your documents are not turned in to the Health Sciences Office by the due date. The estoppel letter notifies you of the effective date for when you are not allowed to attend lectures, campus lab, or clinical lab. Once the documents have been received, the estoppel status will be lifted and you can return to class and labs. Don’t miss due dates.

Page 2 – Requirements List

  1. The top of this page is a list of documents that need to be turned in as part of your clinical packet. Your clinical packet includes the documents that you need to keep with you at your clinical sites. On various occasions you will be asked for your clinical packet to verify that you have been cleared for participating in the clinical setting.
  2. The bottom of this page is a list of the immunizations that you need. If you have questions regarding the immunizations and/or titers, call the Student Health Center at 918-343-7614.
  3. Flu shots are required unless you have a doctor’s note. Tentative dates for the flu shot is from 9/1 – 10/15.

Page 3 – Health Care Provider Statement

This document must be signed by an MD; DO; NP; or PA. If you have any condition that would interfere with your performance (including pregnancy), it must be documented. This requirement is for the protection of the patient, you,  and RSU. If you have a condition that requires accommodations which is later resolved and you are released of the accommodations, then you must have a new Health Care Provider Statement signed at the time you are released.

Page 4 – Physical Abilities Form

This is a list of the activities you might be expected to do, either regularly or occasionally, while you are in the nursing program. If you are not able to do all of these activities, document what accommodations are needed. Indicate at the bottom of the form if you do or do not need accommodations.

Page 5 – Immunization Statement & Waiver

You must sign that you understand and agree to the 6 statements at the top of the page. If you had Chicken Pox, you must check the box stating that you have had varicella (chicken pox). This waiver of the Hep B is only indicating the series is in progress and not completed. You are not able to waive the Hep B series, unless you have a doctor’s note that it is contraindicated.

Page 6 – Student Immunization Record

  1. You will use one immunization record for your clinical packets. 
  2. All copies of your immunizations (including TB test) need to be turned it to the Student Health Center. Call to see if they have your records and if you are missing any immunizations at 918-343-7614.
  3. Once your immunizations and TB are complete, you will receive a completed RSU Immunization Record from the HS 106 office (most likely it will be at the same time as when your background check will be ready).

Page 7 – Background Check Information

Details regarding ordering the background check. If you are worried about any potential issues on your report, please email Dr. Korvick at [email protected].

Page 8 – Your Checklist

A checklist is provided to keep you on track.

Page 9 – Checklist, Document Distribution, & Clinical Packets

  1. Easy to follow list of who gets what.
  2. A copy of this page gets turned in to the HS 106 Office. 
  3. Please put your name at the top of this page, as it will be the cover page for emailed copy of your complete packet (except the drug test).
  4. You will be emailed when both your background check and immunization records have been reviewed and are ready for you to pick up.
  5. When you come in to pick up your copy of the background check and immunization record, please bring copies of all the other documents required for your packet. 
  6. Put the email address on the space provided, for where you want this one time emailed copy of your packet to go.
  7. Be sure that all boxes are checked.
  8. We will scan all documents and keep everything but the background check and immunization record, which you will take with you to be put in your clinical packet.

If you have any questions, please call 918-343-7590.