Medical Information required for
Internship
- Completed
“Internship Medical Information Form” (Form A)
- Documentation
of 2 TB Skin Tests within the 12 months prior to your start date with
Susquehanna Health Intern Program
- Documentation
of 2 doses of Measles, Mumps and Rubella Vaccine
or
Positive Titers for Rubella,
Rubeola and Mumps
- Chicken
Pox:
Documentation of 2
doses of Varicella Vaccine
or
Positive Titer for
Varicella Igg
- For
internship students beginning after July 31, 2010: Submit acceptable
drug test results prior to starting at SH. The drug screen will be
acceptable if done upon enrollment into the student’s academic program as
long as the student/intern remains in the program. If the student stays in
a specific affiliation with SH they will not be required to test again.
For interns with direct patient contact:
- Documentation
of Hepatitis B Vaccine
or
Signed declination
statement for the Hepatitis B Vaccine
All information must
be received by the Employee Health office 7 Business Days prior to the start
date of your internship. Please call if
you have any questions.
Employee Health Services
Susquehanna Health
Divine Providence Hospital
1100 Grampian Blvd.
Williamsport, PA 17701
Phone: 570-320-7449
FAX: 570-320-7422
Updated February 12, 2010