Â鶹¹ú²úAV

PleaseÌýsubmit proof of the following to the CHIP Center and clinical site:Ìý

• Tuberculosis (PPD) screening within 1 year of clinical end date*
• Physical exam within 1 year of clinical end date
• TD/Tdap vaccination within 10 years of clinical end date
• Varicella (Chicken Pox), (must satisfy 1 of 3):
  • Vaccination (2 doses)
  • Immunity (positive titer including lab report)
  • Physician confirmed disease date
• Hepatitis B, (must satisfy 1 of 3):
  • Vaccination series (3 doses)
  • Immunity (positive titer lab report)
  • Signed declination**
• Annual Flu shot or **Ìý
• Annual completion of theÌý.Ìý

Important note:ÌýClinical requirements may vary by clinical site. Please contact your faculty coordinator for site-specific requirements.Ìý

*Nursing students see NUR specific drop down for TB requirement.

**Only permitted for clinical sites that accept declinations; check with your faculty clinical coordinator and contact the CHIP Center for the form.Ìý

• Â鶹¹ú²úAV Clinical Health FormÌý*(stamped or signed by provider)Ìý
• Â鶹¹ú²úAV Clinical Health Form PA StudentsÌý*(stamped or signed by provider)
• Ìý(electronic form)Ìý
• Flu Shot Acknowledgment and Declination FormÌý(paper)Ìý
• Official Health record from a provider’s officeÌý(stamped or signed by provider)
• Official Health record from anÌýonline patient portalÌý
• Health recordÌýfrom anÌýemployerÌý

*Â鶹¹ú²úAV PA students participating in the didactic phase and clinical phase of their program are required to submit the Â鶹¹ú²úAV Clinical Health form. Part 3 (physical exam) MUST be completed and signed by a medical provider.Ìý

• Online (preferred): (take a photo or scan and upload)Ìý
• Fax: 716-839-8230
• Office: Yurtchuk 116 (The CHIP Center)Ìý

• Convenient locationÌýwithin 1 mile of campus
• WNY Immediate Care offers physicals, TB testing, drug screenings, and more for an out of pocket cost. Insurance isÌýnot accepted for this service.Ìý
• Please call aboutÌýadditional services immunizations offered.ÌýÌý

• Vaccinations Offered:ÌýHepatitis A &B, Japanese Encephalitis, MMR (Measles, Mumps & Rubella), Meningitis (MCV4), Rabies, Polio, Td/Tdap, Typhoid, Varicella (Chicken Pox), Yellow Fever.Ìý
• Great Lakes Physician Services also offers school physicals. Please visit Ìýfor more information.Ìý
• Cost:Ìý$50Ìývisit fee. Insurance is NOT accepted. Immunization costs must be paid out of pocket.ÌýCash, check, and credit card accepted. Call for cost of individual vaccines.
• Address:Ìý462 Grider Street, Suite 116 Buffalo, NY 14215
• Hours:ÌýMonday - Friday, 8:00 am- 4:00 pm. By appointment only. No walk-ins.
• Phone: 716-898-4153Ìý

• Vaccinations Offered: Hepatitis A&B, Influenza, MMR (Measles, Mumps & Rubella), Meningitis, Polio, Pneumonia, Rabies, Tdap, Varicella (Chicken Pox), Shingles (Zoster), Yellow Fever, HPV, TB Skin Test, Japanese Encephalitis, Typhoid.Ìý
• Cost: $25 visit fee. Insurance is NOT accepted. Immunization costs must be paid out of pocket. Cash, check, and credit card accepted. Call for cost of individualÌývaccines.
• Address: 2805 Wehrle Drive, Suite 2 Williamsville, NY 14221
• Hours:ÌýMonday - Thursday, 9:00 am- 5:00 pm.ÌýSome weekend hours available. Call for specifics.
• Phone:Ìý855-729-2479Ìý

Ìý

• Vaccinations Offered: Typhoid, Tdap, Hepatitis A & B, MMRÌý(Measles, Mumps &Rubella), Meningitis, Polio, Varicella (Chicken Pox), Haemophilus,Ìý Influenza B, Japanese Encephalitis, Shingles (Zoster), Rabies, Pneumococcal.Ìý
• Cost: $40 visit fee.ÌýInsurance is NOT accepted. Immunization costs must be paid out of pocket. Cash, check, and credit card accepted. Call for cost of vaccines.
• Address: 100 College Parkway,ÌýSuite 260 Williamsville,ÌýNY 14221.Ìý
• Hours:ÌýMonday-Friday 9:30 am- 2:00 pm. By appointment only. No walk-ins.Ìý
• Phone: 716-631-0920

Please note: this is not an exhaustive list of clinics in the area. The resources listed above are included due to the immunizations offered, cost andÌýproximity to campus.Ìý

Students can emailÌýhealth@daemen.eduÌýto request a copy of their health records.

• Nursing students participating in an external learning experience are required to complete the linked . This assessment will be reviewed by the CHIP Center team in place of an annual PPD test. For more information, please contact your faculty clinical coordinator.Ìý
• COVID-19 vaccine requirementsÌývary by clinical site. Please check with your clinical coordinator and clinical site for more information.Ìý
• ALL nursing students (including students completing the program online) participating in an external learning experience are required to be clinically health compliant.
• As a reminder, the CHIP Center does NOT fax or mail immunizations to your clinical sites.

• COVID-19 vaccine requirementsÌývary by clinical site. Please check with your clinical coordinator and clinical site for more information.Ìý
• Letters of intent must be sent to your clinical site prior to the clinical compliance deadline setÌýby your clinical coordinator. For more information, please contact your faculty clinicalÌýcoordinator.Ìý
• As a reminder, the CHIP Center does NOT fax or mail immunizations or letters of intent to your clinical sites.

Typhon

• PA students utilize Typhon during the clinical portion of the programÌýto track progress during rotations. Typhon alsoÌýtracks some health requirements for PA students. As a result, the CHIP Center will update Typhon with the immunization records you submit.Ìý
• Typhon will notify you when a requirement is expiring or past due. Please submit an updated record to the CHIP Center ASAP for that information to be updated.Ìý
• "Immunization" on Typhon = Tuberculosis ScreeningÌý

Other information

• COVID-19 vaccine requirementsÌývary by clinical site. Please check with your clinical coordinator and clinical site for more information.ÌýÌý
• Letters of intent must be sent to your clinical site prior to the clinical compliance deadline setÌýby your clinical coordinator. For more information, please contact your faculty clinicalÌýcoordinator.Ìý
• PA students are REQUIRED to submit the Â鶹¹ú²úAV Clinical Health form. Part 3 of the form(Physical Exam) MUST be completed and signed by a medical provider.Ìý
• As a reminder, the CHIP Center does NOT fax or mail immunizations or letters of intent to your clinical sites.
• Clinical sites may have specific vaccine requirements such as COVID-19 and hepatitis B.Ìý