Prior to assuming your house staff position with Loyola, you are required to comply with several occupational/employee health requirements including:
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completion of a medical/occupational questionnaire |
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compliance with infection control policies regarding immunizations |
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compliance with the TB screening program, and |
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compliance with fit testing for an N95 respirator |
In an effort to assure that you have ample time to comply with the medical center requirements, linked are the following:
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Evaluation History Form, to be completed in its entirety: 335kb |
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OSHA Respirator Medical Evaluation Questionnaire, complete Part A, Section 1 and Part A, Section 2, questions 1-9: 26kb |
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Respirator Issuance and Training Documentation form, top section only: 23kb |
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Request for Medical Clearance form, applicant/employee/patient section only: 37kb |
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Authorization for Release of Medical Record Information, top section and sign and date on the reverse side: 215kb |
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Health Care Consent form, print, sign and date on the reverse side: 184kb |
Additionally, be advised that you are required to provide proof of the following:
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immunity to measles (protective titer or evidence of two immunizations after 12 months of age) |
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immunity to mumps (protective titer or evidence of two immunizations after 12 months of age) |
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immunity to rubella (protective titer or evidence of one immunization after 12 months of age) |
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documentation of hepatitis B immunity (evidence of immunization and/or titer) |
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documentation of TB skin test applied and read during 90 days prior to assuming clinical responsibilities |
All forms and requisite documentation must be returned to the Department of Occupational/Employee Health Services by June 2, 2008.
LUMC Occupational Health Services
1211 W. Roosevelt Road
Maywood, IL 60153
Please be advised that no house officer will be allowed to assume clinical responsibilities until compliance with all of the above occupational health requirements is documented.
Thank you.
Sincerely,
Bryan Yanaga, M.D.
Medical Director
Occupational/Employee Health Services |
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