NOTE: The required items for American Data Bank (ADB) Documentation
Submitted documentation must include the following items
Document lists typeset, name of provider (Exclusive of forms generated by ADB or WGU)
Document lists student name
Document lists service name
Document lists service date
Result with qualitative reference range and/or full interpretation of
If document has a field which indicates a provider signature, document must reflect a provider signature/or signature stamp
Instructions for entering your immunization record
MMR (Measles, Mumps and Rubella) Titer: Update upon expiration; you must submit serological evidence of MMR immunity via an IgG antibody titer screening. Titer must be positive (+) and must be completed within the past 5 years.
Tetanus Diphtheria and a-celluar Pertussis (Tdap): Update upon expiration; you must have a Tetanus, Diphtheria, and a-celluar Pertussis vaccination within the last ten years. If you are unable to provide appropriate documentation showing you have had a vaccination, you must receive another
Varicella Titer: Update upon expiration; you must submit serological evidence of varicella immunity via an IgG antibody titer screening. Titer must be positive (+) and must be completed within the past 5 years.
Influenza vaccine (or declination form): A seasonal flu vaccination is required on an annual basis. Declining the flu shot may preclude you from being able to attend clinical. If you choose to decline the flu shot, you must get a declination form from Health Placement at WGU. The completed form will need to be upload to your compliance account.
Tuberculosis (PPD): Annual submission; you must have documentation of current tuberculosis screening every year while at WGU. Acceptable TB testing includes either a, or b, or c:
You must submit a 2-Step PPD, with the 2nd PPD being within 7-10 days from the 1st PPD. If both PPDs are negative, you must submit an annual PPD
QuantiFERON Gold blood TB test
If you have a Positive PPD: You must supply printed proof of the date you tested positive, a Chest X-Ray (every two years) AND a TB Screening Report (Annually-see form, located under the “Get Started” category within your Complio compliance account) from your provider. This report must state that you, the patient, are ‘negative’ for signs and symptoms of tuberculosis. This report must be submitted annually, with the newest within 12 months of admission to WGU.
Hepatitis B titer: Update upon expiration; you must submit serological evidence of Hepatitis B immunity via an IgG antibody titer screening. Titer must be positive (+) and must be completed within the past 5 years.
CPR Certification: Expires every two years. You must have the American Heart Association (AHA) Basic Life Support (BLS) CPR Certification on file before the beginning of your first clinical nursing course. It is your responsibility to remain current in your CPR certification during the program, any student not certified through the American Heart Association will not be allowed to attend clinical. Please enter the date issued, and type of card (as the ‘Provider’) in the system, and send a copy of the front and back of your CPR card to your
Health Insurance: Update upon expiration; typically You must show evidence of health insurance coverage prior to your first lab at WGU and annually thereafter.
Physical Exam: One time submission of a physical examination within the last year utilizing the WGU form provided for you. Have your provider sign the form, checking off that you are/are not recommended for clinical experiences. (See form, located under the “Get Started” category within your Complio compliance account)
Provider Attestation Form: One time submission. You must have your provider complete the Healthcare Provider Attestation Form. (See form, located under the “Get Started” category within your Complio compliance account)
Student Attestation Form: One time You must complete the Student Attestation Form and enter the completed date in the system. (See form, located under the “Get Started” category within your Complio compliance account)
Contact your State Director of Nursing via email or a member of the Health Placement Team firstname.lastname@example.org with questions or concerns.