Due to an increase in communicable illnesses, St. Anthony Regional Hospital and Nursing Home has implemented a temporary visitor restriction, asking that only immediate family members over 18 years of age visit residents of the Nursing Home, and only spouses or significant others visit patients in the hospital at this time. We appreciate your understanding, and will communicate when the restrictions are lifted.
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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.