Nursing Health Requirements

Newly-accepted and continuing students within a Nursing Program or the Surgical Technology Program at Kapiʻolani Community College are required to provide and maintain specific health information in order to obtain clearance to participate in the clinical practicum segment within their clinical-based courses. The Nursing Department has established health requirement guidelines and deadlines so as to respond to the health care facilities’ expectation that students are cleared to participate in their clinical practicum on a timely basis. (The health requirements will vary slightly if enrolling in the KCC Long-Term Care Nurse Aide Program.)

Students who are deficient in any one requirement will not be permitted to enter the clinical area and/or may not be able to register for their courses. A student may be asked to withdraw from the program if the deficiency is not cleared on a timely basis. It is the responsibility of each student to keep these requirements and certifications current throughout the duration of enrollment.

Criminal background check and urine drug screening may be required by a specific health care facility or agency. Students will be notified accordingly, if a criminal background check and urine drug screening are required.

New students must complete their health requirements by the deadline as referenced within their acceptance notification letter. Admission into the program may be canceled without further notification if all health requirements are not completed satisfactorily by the specified deadline. Students deemed as alternates are encouraged (but not required) to complete their health requirements in the event they are offered admissions.

Continuing students must maintain their health requirements which include tuberculosis clearance, influenza vaccination (or declination) and CPR for health care provider (with AED) certification, ultimately updating and/or providing the aforementioned health requirements by the deadlines referenced below.

  • July 1st, if enrolling in nursing courses in the Fall semester.
  • November 1st, if enrolling in nursing courses in the Spring semester.
  • April 1st, if enrolling in nursing courses in the Summer term.

General Instructions Relating to Submission of Health Information:

  1. Submit all health documents by the specified deadline.
  2. These documents are required by the various health care facilities you may be attending. If the information is incomplete or inaccurate, you will be withheld from participating in the clinical training.
  3. Duplicate all health documents and submit the duplicated copy to the Nursing Department. Once documents are submitted to the Nursing Department, these documents become the property of the college and cannot be returned or copied. Keep all original health documents for your own records. Submit all Nursing Department forms which require your original signature, while retaining a copy of these forms for your records.
  4. Submit your health documents in a letter-sized manila envelope or a plastic sheet protector, so as to ensure that the forms are kept together and protected from damage.
  5. Submit all health documents to the “Health Document” mailbox within the KCC Nursing Department in the Kopiko Building, Room 201. Although students are encouraged to hand-deliver their health documents to the Nursing Department, you may mail in your health documents to the following address:

Kapi‘olani Community College (Nursing Department)
Kopiko Building, Room 201
4303 Diamond Head Road, Honolulu, HI 96816
Attention: Kristy Yoshikawa

Health Forms

Students newly admitted into a Nursing Program or the Surgical Technology Program must complete a series of health forms in preparation for entry into the program. Please read carefully through the related health requirement information to ensure that you complete all health forms on a timely basis.

Admission into the nursing program may be canceled without further notification if all health requirements and forms are not completed satisfactorily by the specified deadline. Students deemed as alternates are encouraged (but not required) to complete their health requirements in the event they are offered admissions.

  • Student Health Checklist, KCC Nursing Department: Please download a copy of the checklist and use it as a guide to ensure your completion of all health requirements for your program. Please submit this checklist with all of your health documents. Please be sure to complete the checklist by including your name, contact information and all other specified information. (Submit the original form.)
  • Health Requirements Submission Agreement, KCC Nursing Department: After reading the corresponding Health Requirements Submission Agreement, please download a copy of the Agreement Form and be sure to date and sign the form. (Submit the original form.).
  • Physical Examination Clearance, KCC Nursing Department: Please download a copy of the form, whereupon your primary care provider (PCP) must complete a physical exam for you and indicate that you are able to meet the essential performance requirements. Please be sure that the form is dated and signed by your primary care provider within six months prior to the start of the nursing program. (Submit the original form.)

Communicable Illness or Health Problem Advisory: A student with a communicable illness or health problem that may interfere with their performance may not attend class or the clinical practicum. The student may return only after presenting written medical clearance from their primary care provider to the instructor. The primary care provider must specify whether the student can carry out assignments in the classroom and in the clinical practicum.

Pregnancy Advisory: A student who becomes pregnant must notify the Nursing Department Chairperson and health clearance coordinator as soon as pregnancy is confirmed so arrangements can be made to facilitate the protection of the student and the fetus. Pregnant students should be aware that there are many potential risks to the fetus in the hospitals such as radiation, anesthesia and communicable diseases. Pregnant students must provide written statement from their primary care provider approving continuation in the nursing program and verifying the duration of the pregnancy.

  • Tuberculosis (TB) Clearance: Documentation of a two-step (two separate injections placed seven days apart and read two days later) with PPD skin test showing the measurement of the indurations (even if negative or 0mm) or negative PPD for this current year and last year (must be two consecutive years not more than 365 days apart) also showing the indurations (size) or if you had a positive PPD, provide a copy of the card showing the date and size of the positive reading with a copy of the results of your latest negative chest x-ray. If your x-ray was more than a year ago, you must update the x-ray. Note: If you have a current TB clearance, it must be good through the end of the semester, wherein your TB clearance cannot expire within the semester you are currently enrolled.
  • Download a list of places that offer Tuberculosis testing. TB Clinics (PDF).
  • Waiver of Annual Chest X-ray for TB Clearance, KCC Nursing Department: Only if you have had a positive skin test and negative chest x-ray in the past year, please download a copy of the form and complete the form accordingly. (Submit the original form.)
  • Hawai‘i Pacific Health (HPH) Tuberculosis (TB) Questionnaire: Please download a copy of the form and read it carefully. You and a healthcare professional must review the form after which you and the healthcare professional must sign and date the bottom portion of the form. (Submit the original form.) Note: Although the form instructs students to submit the form to “your employee Health Facility office,” please submit the form to the KCC Nursing Department.
  • Tripler Army Medical Center (TAMC) Health Care Worker Tuberculosis Risk Assessment Tool: Please download a copy of the form and read it carefully. You and a healthcare professional must review the form after which you and the healthcare professional must sign and date the bottom portion of the form. (Submit the original form to the KCC Nursing Department.)
  • Vaccination and Titer Requirements: You must complete a blood titer test via your personal physician (or primary care provider); public health clinics (e.g., Kalihi-Palama, Waikiki, etc.) or UH-Manoa Student Health Services. Please read the instructions below carefully and submit copies of health documents accordingly.
    • Measles (Rubeola): Documentation of a positive blood titer and the date of when the sample was collected.
    • Mumps: Documentation of a positive blood titer and the date of when the sample was collected.
    • Rubella: Documentation of a positive blood titer and the date of when the sample was collected.
    • Varicella (Chicken Pox): Documentation of a positive blood titer and the date of when the sample was collected. Please note that a past history of having the disease is not acceptable in the healthcare field.
    • Hepatitis B: Documentation of a positive Hepatitis B blood titer (HBsAb) and the date of when the sample was collected. If any of the blood titer results are negative or equivocal, student must work with their primary care provider on getting a positive result. The Center for Disease Control (CDC) recommendation is to start the immunization series, complete the entire series, then re-titer within 4-6 weeks after the last vaccination.
    • Tetanus, Diphtheria and Pertussis (Tdap): Documentation of a Tetanus vaccination within the past ten years. (Note: Tetanus vaccination not required for Nurse Aide Program.)
    • Influenza Vaccine: Proof of most recent/current seasonal influenza vaccination or completion of influenza vaccination declination. Please also submit the HPH Non-Employee Inactivated Influenza Vaccine Declaration Form and the KCC Influenza Attestation/Declination Form, signed and dated, when submitting your proof of influenza vaccination.
    • For a listing of places that offer MMR immunizations, please click to MMR Clinics.
    • Download a list of places that offer titer/blood testing. Titer/Blood Testing Agencies.
  • Hepatitis B Immunization Consent, KCC Nursing Department: Please download a copy of the form, after which, please complete the form to affirm that you have read and understand the benefits and risks of receiving the immunization. Indicate with an “x” next to the statement that appropriately applies to you. Be sure to date and sign this form. (Submit the original form.)
  • Hepatitis B Immunization for Health Education Students, KCC Nursing Department: Please download a copy of the form and read the information carefully for your reference.
  • Hawai‘i Pacific Health (HPH) Non-Employee Inactivated Influenza Vaccine Declaration Form: Please download a copy of the form and read it carefully; after which, you must complete the form and affix your signature on the form. (Submit the original form.)
  • Influenza Vaccination Information Statement: Please download a copy of the form and read the information carefully for your reference.
  • Influenza Vaccination Attestation/Declination Form, KCC Nursing Department: Please download a copy of the form and read it carefully; after which, you must complete the form and affix your signature on the form. (Submit the original form.)
  • CPR for Health Care Provider with AED Certification or BLS Provider: This CPR certification includes Adult CPR (one and two rescuer), Child and Infant CPR, obstructed airway management and AED use. Submit a copy of your current CPR card (expires within one to two years). Certification must be current and valid until the completion of the course (renewals must be submitted four to six weeks before the start of the next semester). Be sure both the front and back of the card is duplicated.Note: The Nursing Department will not accept Heartsaver, Community CPR, Adult CPR, Heartsaver Plus or Professional Rescuer certification (unless it is CPR/AED for the Professional Rescuer). A listing of agencies offering CPR and First Aid training is available.
  • First Aid Certification: First aid certification is good for up to three years. Check your expiration date. Students must submit a copy of a current First Aid card. Be sure both the front and back of the card is duplicated.(Note: First aid certification only required for Nurse Aide Program and the Surgical Technology Program.) A listing of agencies offering CPR and First Aid training is available.
  • Medical Consent Form, KCC Nursing Department: Please download a copy of the form and read it carefully; after which, you must complete the form and affix your signature on the form. (Submit the original form.)
  • Understanding and Agreement Form, KCC Nursing Department: Please download a copy of the form and read it carefully; after which, you must complete the form and affix your signature on the form. (Submit the original form.)
  • Exclusion of Worker’s Compensation Coverage/Confirmation of Health Insurance Coverage Form, KCC Nursing Department: Please download a copy of the form and read it carefully in order to understand the limits of workers’ compensation and to understand the need for health insurance coverage; after which, you must complete the form, affix your signature on the form and attach a copy of your health insurance card to verify your health insurance coverage. (Submit the original form.)When submitting a copy of your health insurance card, please be sure that the card clearly shows the subscriber’s name, policy number, group number and expiration date (if any). Students who need health insurance can visit the KCC Student Activities Office in ‘Iliahi 126
  • Document Release Form, KCC Nursing Department: Please download a copy of the form and read it carefully; after which, you must complete the form and affix your signature on the form. (Submit the original form.)
  • Liability Insurance (Medlcal Malpractice Insurance):Liability insurance helps protect you in case of a lawsuit and is available through Kapi‘olani Community College. In order to participate in the clinical practicum within the nursing courses, students must purchase the liability insurance. The cost of the liability insurance is $15 per academic year (August 1st to July 31st). The liability insurance fee is attached to a specific nursing course and is paid when you register for the nursing course and make payment on the tuition and fees for the course.For the Surgical Technology Program, a separate form is used to purchase the liability insurance. The Nursing Department will issue the Health Students/Liability Insurance Application to enable the Surgical Technology student to purchase liability insurance. Please complete the form and submit the form with your $15 payment to the KCC Continuing Education/Registration Office in ‘Ilima 102.

Additional Health Information

  • Photo ID Badge Form, KCC Nursing Department: Please download a copy of the form and read it carefully; after which, you must complete the form. (Submit the original form to the KCC Office of Student Activities in ‘Iliahi 126, after attending the New Student Orientation Session for the Nursing Program or the Surgical Technology Program.)
  • KCC Nursing Department Safety Rules: Please download a copy of the form and read the information carefully in order to familiarize yourself with the rules to protect the health, safety and welfare of yourself, your patients and other members of the College community.
  • UH Mānoa Student Health Services: To familiarize yourself with the student health services offered by UH-Manoa for KCC students.If you have any questions regarding your health requirements, please contact Sarah Perkins, RN at 808.734.9494, nurslist@hawaii.edu or fax 808.734.9147.

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