[{"data":1,"prerenderedAt":-1},["ShallowReactive",2],{"detail-sidebar-cat-0-en-105":3,"doc-seo-430748-105":59,"doc-detail-430748-en":131},{"code":4,"msg":5,"data":6},0,"success",[7,13,18,23,28,33,38,43,48,51,55],{"id":8,"doc_module":4,"doc_module_name":9,"category_name":10,"show_sort_weight":11,"slug":12},1,"Document","Story & Novel",90,"story-novel",{"id":14,"doc_module":4,"doc_module_name":9,"category_name":15,"show_sort_weight":16,"slug":17},2,"Literature",80,"literature",{"id":19,"doc_module":4,"doc_module_name":9,"category_name":20,"show_sort_weight":21,"slug":22},4,"Exam",70,"exam",{"id":24,"doc_module":4,"doc_module_name":9,"category_name":25,"show_sort_weight":26,"slug":27},5,"Comic",60,"comic",{"id":29,"doc_module":4,"doc_module_name":9,"category_name":30,"show_sort_weight":31,"slug":32},6,"Technology",50,"technology",{"id":34,"doc_module":4,"doc_module_name":9,"category_name":35,"show_sort_weight":36,"slug":37},7,"Healthcare",40,"healthcare",{"id":39,"doc_module":4,"doc_module_name":9,"category_name":40,"show_sort_weight":41,"slug":42},8,"Research & Report",30,"research-report",{"id":44,"doc_module":4,"doc_module_name":9,"category_name":45,"show_sort_weight":46,"slug":47},9,"Religion & Spirituality",20,"religion-spirituality",{"id":46,"doc_module":4,"doc_module_name":9,"category_name":49,"show_sort_weight":46,"slug":50},"World Cup","world-cup",{"id":52,"doc_module":4,"doc_module_name":9,"category_name":53,"show_sort_weight":52,"slug":54},10,"Lifestyle","lifestyle",{"id":56,"doc_module":4,"doc_module_name":9,"category_name":57,"show_sort_weight":24,"slug":58},19,"General","general",{"code":4,"msg":60,"data":61},"ok",{"site_id":62,"language":63,"slug":64,"title":65,"keywords":66,"description":67,"schema_data":68,"social_meta":124,"head_meta":126,"extra_data":128,"updated_unix":130},105,"en","flu-vaccination-form-college-of-nursing-nursing-students-clinical-season-proof","FLU VACCINATION FORM - College of Nursing - Nursing students clinical season proof","","Flu Vaccination Form for College of Nursing requires nursing students in clinical experiences to receive an annual seasonal influenza vaccine and submit proof by October 15 of the current flu season. The form includes a health professional section to document vaccine administration details, signature, and provider information, or to record medical contraindication with an explanation. It also outlines how to request an exemption, submit supporting materials, and manage View Point Screening outcomes, including possible program and employment impacts.",{"@graph":69,"@context":123},[70,84,106],{"@type":71,"itemListElement":72},"BreadcrumbList",[73,77,79,82],{"item":74,"name":75,"@type":76,"position":8},"https://docshare.wps.com","Home","ListItem",{"item":78,"name":9,"@type":76,"position":14},"https://docshare.wps.com/document/",{"item":80,"name":35,"@type":76,"position":81},"https://docshare.wps.com/document/healthcare/",3,{"item":83,"name":65,"@type":76,"position":19},"https://docshare.wps.com/document/flu-vaccination-form-college-of-nursing-nursing-students-clinical-season-proof/430748/",{"url":83,"name":65,"@type":85,"image":86,"author":91,"headline":65,"publisher":94,"fileFormat":97,"inLanguage":63,"description":67,"dateModified":98,"datePublished":99,"encodingFormat":97,"isAccessibleForFree":100,"interactionStatistic":101},"DigitalDocument",{"url":87,"@type":88,"width":89,"height":90},"https://docshare.wps.com/thumbnails/flu-vaccination-form-college-of-nursing-nursing-students-clinical-season-proof/430748.png","ImageObject",300,407,{"name":92,"@type":93},"Grenda","Person",{"url":74,"name":95,"@type":96},"DocShare","Organization","application/pdf","2026-10-30","2026-09-29",true,{"@type":102,"interactionType":103,"userInteractionCount":105},"InteractionCounter",{"@type":104},"ViewAction",14,{"@type":107,"mainEntity":108},"FAQPage",[109,115,119],{"name":110,"@type":111,"acceptedAnswer":112},"What is the deadline to provide flu vaccination proof for the current season?","Question",{"text":113,"@type":114},"Proof must be provided by October 15 of the current flu season.","Answer",{"name":116,"@type":111,"acceptedAnswer":117},"What information must the health professional complete when the flu vaccine is administered?",{"text":118,"@type":114},"The health professional must enter the date vaccine was administered for the flu season, documentation of acceptance of flu mist when applicable, and include the administered-by signature, print name, date signed, and provider name and address.",{"name":120,"@type":111,"acceptedAnswer":121},"How does a student request an exemption from the flu vaccine requirement?",{"text":122,"@type":114},"The student must request an exemption by checking the box, signing and dating, then complete Med-Proctor immunization requirements and exemption application, upload the College of Nursing approval letter into View Point Screening, and follow the detailed instructions provided.","https://schema.org",{"og:url":83,"og:type":125,"og:title":65,"og:site_name":95,"og:description":67},"article",{"robots":127,"canonical":83},"index,follow",{"doc_id":129,"site_id":62},430748,1790790722,{"code":4,"msg":5,"data":132},{"doc_id":129,"user_id":133,"nickname":92,"user_avatar":134,"doc_module":4,"category_id":34,"category_name":35,"doc_title":65,"doc_description":67,"doc_content":135,"file_id":136,"file_url":137,"file_type":138,"file_size":139,"view_count":105,"is_deleted":4,"is_public":8,"is_downloadable":8,"audit_status":8,"page_count":8,"language":140,"language_code":63,"site_id":62,"html_lang":63,"table_of_contents":141,"faqs":142,"seo_title":143,"seo_description":67,"update_tm":144,"read_time":81,"preview_page_count":4},7971474921005,"https://ap-avatar.wpscdn.com/davatar_29158cc5080c5b710cf443261637dec0","College of Nursing  \n3800 Victory Parkway Cincinnati, OH 45207-7351 513 745-3814  \nFLU VACCINATION FORM  \nNursing students participating in clinical experiences are required to receive the seasonal flu vaccine annually and provide proof by OCTOBER 15th of the current flu season. Alternate verification of vaccination is acceptable if it includes [the necessary information.](the necessary information. Instructions for submission of documentation are at www.xavier.edu/nursing/Current)[ Instructions for submission of documentation are at](the necessary information. Instructions for submission of documentation are at www.xavier.edu/nursing/Current)[ ](the necessary information. Instructions for submission of documentation are at www.xavier.edu/nursing/Current)[www.xavier.edu/nursing/Current](the necessary information. Instructions for submission of documentation are at www.xavier.edu/nursing/Current)Students.cfm  \nStudent Name   Date ofBirth   \n\n| HEALTH PROFESSIONAL: COMPLETE THIS SECTION |  |\n| --- | --- |\n|   Flu vaccine administered on (DATE)   for flu season   Flu mist is acceptable for students to receive if they do not care for patients in isolation/contraindications.\u003Cbr>Administered by (Signature) (Print Name) Date Signed\u003Cbr>Provider name and address:\u003Cbr>_____________________________________________\u003Cbr>_____________________________________________\u003Cbr>_____________________________________________ |  |\n|  | The vaccine is contraindicated. Health professional explanation: |\n| |  |\n| Health Professional Signature (Print Name) Date Signed\u003Cbr>(if vaccine is contraindicated) Also complete Provider name and address section. |  |\n| To | request an exemption please check the box below, sign and date, then follow the instructions detailed below.\u003Cbr>I decline the vaccine. Student signature   Date   |\n| |  |\n| 1. Complete Med-Proctor Immunization requirements and application for exemption.\u003Cbr>• [https://www.xavier.edu/health-wellness/health/exemptions](https://www.xavier.edu/health-wellness/health/exemptions and direct questions)[ and direct questions](https://www.xavier.edu/health-wellness/health/exemptions and direct questions) to battagliaa@xavier.edu or 513-745-4823.\u003Cbr>2. Upload the XU College of Nursing’s approval letter into View Point Screening.\u003Cbr>• This will be sent to you via email from Amy Wilson, [battagliaa@xavier.edu](battagliaa@xavier.edu)\u003Cbr>3. Anticipate that your View Point requirement will remain rejected throughout the program to act as a reminder.\u003Cbr>• The student and coordinators must request exemption allowance every semester and with every new clinical facility.\u003Cbr>\u003Cbr>Students may seek exemption to the immunization and vaccination requirements from Xavier, but must be aware that the clinical partner institutions may not recognize the immunization exemption. In such circumstances, Xavier will take reasonable steps to find an alternative clinical placement, but cannot guarantee that such a placement will exist. Further, an exemption may result in a student’s inability to complete the program and/or preclude employment at some sites upon graduation. |  |\n\nFlu_form Rev. 11/14/2024","cbCaimmPFouy9lXT","https://ap.wps.com/l/cbCaimmPFouy9lXT","pdf",96726,"English","# Health Professional Section\n## Vaccine administered documentation\n## Medical contraindication option\n# Exemption Request Process\n## Med-Proctor and application steps\n## Approval letter upload to View Point Screening\n## Program impact and expectations","[{\"question\":\"What is the deadline to provide flu vaccination proof for the current season?\",\"answer\":\"Proof must be provided by October 15 of the current flu season.\"},{\"question\":\"What information must the health professional complete when the flu vaccine is administered?\",\"answer\":\"The health professional must enter the date vaccine was administered for the flu season, documentation of acceptance of flu mist when applicable, and include the administered-by signature, print name, date signed, and provider name and address.\"},{\"question\":\"How does a student request an exemption from the flu vaccine requirement?\",\"answer\":\"The student must request an exemption by checking the box, signing and dating, then complete Med-Proctor immunization requirements and exemption application, upload the College of Nursing approval letter into View Point Screening, and follow the detailed instructions provided.\"}]","FLU VACCINATION FORM - College of Nursing - Nursing students clinical season proof | PDF",1790653607]