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 Kapiʻolani CC 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 notice 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 admission.

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

Submission of Health Information:

• Submit all health documents by the specified deadline utilizing the Complio website dedicated to the Kapiʻolani Community College Nursing Programs and Surgical Technology Program.
• 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.

Submission of Health Information for NURSE AIDE Students:

• Please consult with your nurse aide instructor for the submission of your health documents, wherein your nurse aide instructor will work with the Nursing Department Clinical Compliance Coordinator to process your health documents accordingly.
• Your timely submission of health documents will help to ensure your clinical practicum placement on a timely basis.
• If you have any questions, contact us at nurshlth@hawaii.edu.

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 notice 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 admission.

Student Health Checklist (for ADN, Transition & PRCN Programs) (pdf), Kapiʻolani CC 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. All health requirements and the submission of related health documents should be completed via the Complio website which is used to upload and track your health documents.

Student Health Checklist Guide (for ADN, Transition & PRCN Programs) (pdf), Kapiʻolani CC Nursing Department: Please download the guide which serves as a reference for completing the Student Health Checklist.

Student Health Checklist (for Nurse Aide Program) (pdf), Kapiʻolani CC 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. All health requirements and the submission of related health documents should be completed via the Complio website which is used to upload and track your health documents.

Physical Examination Clearance (pdf), Kapiʻolani CC 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. The form must be uploaded to the Complio website which is used to track your health documents

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 a 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 done 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 locations (pdf) that offer Tuberculosis testing from the State of Hawaii, Department of Health – Tuberculosis Control Program.

Waiver of Annual Chest X-ray for TB Clearance (pdf), Kapiʻolani CC 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 (pdf): 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 Kapiʻolani CC Nursing Department.

Tripler Army Medical Center (TAMC) Health Care Worker Tuberculosis (TB) Risk Assessment Tool(pdf): 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. Please exclude your Social Security number when completing the “Patient Identification” section of the form. (Submit the original form to the Kapiʻolani CC Nursing Department.)

Queen’s Health Systems Tuberculosis Monitoring Form (pdf): Please download a copy of the form and read it carefully; after which, please sign and date the bottom of the form. (Submit the original form to the Kapiʻolani CC Nursing Department.)

Castle Medical Center TB Skin Test (TST) and Questionnaire (pdf): Please download a copy of the form and read it carefully; after which, please sign and date the bottom of the form. (Submit the original form to the Kapiʻolani CC Nursing Department).

Vaccination and Titer Requirements: You must complete a blood titer test via your personal physician (or primary care provider) or be referred by your personal physician to a blood titer/testing agency. If an immunization booster is recommended after completing the blood titer testing, please consult with your personal physician about a referral for an immunization. Please read the instructions below carefully and submit copies of health documents accordingly.

• • • Measles (Rubeola): Documentation of a positive blood titer and the date when the sample was collected.
    • Mumps: Documentation of a positive blood titer and the date when the sample was collected.
    • Rubella: Documentation of a positive blood titer and the date 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, students 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 Kapiʻolani CC Influenza Attestation/Declination Form, signed and dated, when submitting your proof of influenza vaccination.
    • Download a list of places that offer titer/blood testing. Titer/Blood Testing Agencies (pdf).

Hepatitis B Immunization Consent (pdf), Kapiʻolani CC Nursing Department: Please download a copy of the form; after which, please complete the form to affirm that you have read and understood the benefits and risks of receiving the immunization. Indicate with an “x” next to the statement that appropriately applies to you. The form must be uploaded to the Complio website which is used to track your health documents.

Hepatitis B Immunization for Health Education Students (pdf), Kapiʻolani CC 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 (pdf): 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.)

American Heart Association’s Basic Life Support Provider level for healthcare professionals (pdf): Only American Heart Association (AHA) Authorized Training Center offers this course. Please check to see that the CPR training organization you are interested in provides this specific CPR training. Please submit a copy of your certification card (both front and back) and be sure that the back is signed. A copy of your CPR certification card (front and back) must be uploaded to the Complio website which is used to track your health documents. Your CPR certification cannot expire within the semester you are entering. Once in the program, you will need to submit an updated certification CPR card at least eight to ten weeks before the start of the next semester in order to maintain health clearance for your clinical practicum. A listing of agencies offering CPR training is available. Note: The Nursing Department will NOT accept Heartsaver, Community CPR, Adult CPR, Heartsaver Plus, or Professional Rescuer certification and CPR/AED for the Professional Rescuer. However, the Nursing Department will accept the BLS Provider level training that is offered by an American Heart Association-authorized training center.

Medical Consent Form (pdf), Kapiʻolani CC 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 (pdf), Kapiʻolani CC 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 (pdf), Kapiʻolani CC 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 Kapiʻolani CC Student Activities Office in ‘Iliahi 126

Document Release Form (pdf), Kapiʻolani CC 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 (Medical 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 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 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 Kapiʻolani CC Continuing Education/Registration Office in ‘Ilima 102.

Additional Health Information

Photo ID Badge Update: Effective immediately, the Photo ID Badge Form will no longer be needed for new (nursing/surgical technology) students seeking to purchase their photo ID badge for the first time, since the Nursing Department will communicate directly with the Office of Student Activity to confirm the student’s eligibility to purchase a photo ID badge after the student has completed the required new student orientation session for the nursing programs and the surgical technology program. Current nursing/surgical technology program students seeking a replacement badge should contact a Nursing Department counselor, who will authorize the student’s purchase of a replacement badge with the Kapi’olani CC Office of Student Activities.

Kapiʻolani CC Nursing Department Safety Rules (pdf): 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.

COVID Advisories

• COVID Notice to Students Reporting COVID Issue: This advisory is posted within the nursing labs so as to ensure that nursing students are informed of the proper steps to follow if they are exposed to or contract the COVID-19 virus while utilizing the nursing lab.
• Kapi‘olani CC Procedures for Potential COVID-19 Exposure: As referenced within the “Kapi‘olani CC Guidelines for Returning to Campus,” this advisory is provided for all students, faculty, and staff so as to ensure that individuals are informed of the proper steps to follow if they are exposed to or contract the COVID-19 virus while on/off campus.
• Kapi‘olani CC Guidelines for Returning to Campus: These guidelines are provided for all students and employees so as to ensure that individuals returning to campus in the Fall 2020 and thereafter are informed of and adhere to proper measures in order to mitigate the spread of the COVID-19 virus.