KPNSA Sponsored Graduate Nursing Student Health Requirement

All graduate nursing students are required to submit health and program-related requirements. This form is available to eligible students in lieu of paying CastleBranch to review health requirements. In addition to this approved form, all students must complete a separate Background Check and Drug Screen via CastleBranch. Students must provide a copy of a valid RN license and proof of annual Influenza Vaccination.

Eligibility Determination

Are you a KPNSA sponsored student in a graduate nursing program?

Are the below health records on file with your employer?

Current BLS certification via American Health Association (renew every 2 years)
Annually Updated Health Requirements
Tuberculosis Testing – PPD Skin Test (chest x-ray, if needed) or Quantiferon Blood Test
Record of Healthcare Services Received
- Physical Review complete
- Tdap Booster complete
- Titers Information on agency letterhead/form:
  - Measles
  - Mumps
  - Rubella
  - Hepatitis B
  - Varicellas

If you answered YES TO ALL above, please complete the form below and upload your RN license and flu vaccine to the USF Student Hub for review.

If you answered YES TO SOME or NO TO ALL, then you are not eligible to complete this form. Please upload the applicable requirements in the Document Manager of your CastleBranch account. To review the detailed list of the School of Nursing and Health Professions health requirements, visit our Health Requirements for Clinical-Based Programs page and scroll down to Graduate Programs for the CastleBranch Health Requirements Guidelines.

If you have any questions please contact the Graduate Nursing Programs Team.

Student Name

CWID

Please provide the name and site of the employer where you will perform your clinical/practicum/field coursework:

Employer Name

Employer Address

Start Date of Your Employment at this Facility

RN License Number

State Issuer of RN License

Date Issued

Expiration Date

Your health immunizations and certifications must be current and all of your health clearance information must be current and on file with your employer identified above.

Today's Date

Student Signature

Using your cursor, sign in the gray area above.

By completing this form, you attest that you are currently employed and your health records are on file with you employer. If requested, you will be able to provide proof of valid health records within 48 business hours. You further attest that your employer-held health records are equal to those required by the University of San Francisco, School of Nursing and Health Professions’ program health requirements (as listed above).