*** You can now access your health portal information from your smartphone! Just visit the Apple or Google Play store and search for and download the MEDITECH Mhealth app. Once that is downloaded and you open the app you will see "Choose a portal near me". Click on St. Anthony Regional Hospital and log-in to your portal! It's that easy! If you have any questions or issues regarding the portal app you may contact us at 712-794-5906 or email us at firstname.lastname@example.org.
All fields marked with * are required.
Please complete the confidential form below prior to your first clinical date at St. Anthony.
Please upload a copy of all past immunizations, including all those received as an infant or child and / or you may continue to sections below.
Seasonal flu shots (October 1st through March 31st) are required for any student that comes into St. Anthony Regional Hospital during flu season.
Hepatitis B vaccinations are not a requirement, but recommended for anyone at risk for exposure to blood and/or blood products. A declination must be completed if applicable.
Stated history of Chicken Pox, two Varicella vaccinations OR a positive titer will be accepted.
Have you had any of these signs/symptoms in the last year? (All questions must be answered.)
I certify that all of the statements provided here are true and correct to the best of my knowledge.