[{"data":1,"prerenderedAt":-1},["ShallowReactive",2],{"detail-sidebar-cat-1-en-105":3,"doc-seo-287171-105":53,"doc-detail-287171-en":126},{"code":4,"msg":5,"data":6},0,"success",[7,14,19,24,29,34,39,44,49],{"id":8,"doc_module":9,"doc_module_name":10,"category_name":11,"show_sort_weight":12,"slug":13},11,1,"Template","Presentations",90,"presentations",{"id":15,"doc_module":9,"doc_module_name":10,"category_name":16,"show_sort_weight":17,"slug":18},12,"Resumes",80,"resumes",{"id":20,"doc_module":9,"doc_module_name":10,"category_name":21,"show_sort_weight":22,"slug":23},14,"Invoices",70,"invoices",{"id":25,"doc_module":9,"doc_module_name":10,"category_name":26,"show_sort_weight":27,"slug":28},15,"Posters",60,"posters",{"id":30,"doc_module":9,"doc_module_name":10,"category_name":31,"show_sort_weight":32,"slug":33},16,"Social Media",50,"social-media",{"id":35,"doc_module":9,"doc_module_name":10,"category_name":36,"show_sort_weight":37,"slug":38},17,"Forms",40,"forms",{"id":40,"doc_module":9,"doc_module_name":10,"category_name":41,"show_sort_weight":42,"slug":43},18,"Letters",30,"letters",{"id":45,"doc_module":9,"doc_module_name":10,"category_name":46,"show_sort_weight":47,"slug":48},21,"Paper Templates",5,"papers-templates",{"id":50,"doc_module":9,"doc_module_name":10,"category_name":51,"show_sort_weight":4,"slug":52},158,"General","general-158",{"code":4,"msg":54,"data":55},"ok",{"site_id":56,"language":57,"slug":58,"title":59,"keywords":60,"description":61,"schema_data":62,"social_meta":119,"head_meta":121,"extra_data":123,"updated_unix":125},105,"en","missing-immunization-form-norquest-college","Missing Immunization Form - NorQuest College","","This document serves as an official request form for NorQuest College students who are unable to receive mandatory immunizations or health tests due to medical reasons. The form requires students to provide personal identification, program details, and specific information regarding the medical exemption, accompanied by a formal doctor's note. By signing this document, the student grants consent for the disclosure of their personal and medical information to the Centre for Growth & Harmony, the Faculty of Health and Community Studies Work-Integrated Learning Team, and relevant external healthcare agencies such as Alberta Health Services. This process ensures that practicum placement requirements are appropriately managed while complying with the Alberta Freedom of Information and Protection of Privacy Act. Following submission, the Work-Integrated Learning Team reviews the request and contacts the student to discuss their status and practicum eligibility.",{"@graph":63,"@context":118},[64,80,101],{"@type":65,"itemListElement":66},"BreadcrumbList",[67,71,74,77],{"item":68,"name":69,"@type":70,"position":9},"https://docshare.wps.com","Home","ListItem",{"item":72,"name":10,"@type":70,"position":73},"https://docshare.wps.com/template/",2,{"item":75,"name":36,"@type":70,"position":76},"https://docshare.wps.com/template/forms/",3,{"item":78,"name":59,"@type":70,"position":79},"https://docshare.wps.com/template/missing-immunization-form-norquest-college/287171/",4,{"url":78,"name":59,"@type":81,"image":82,"author":87,"headline":59,"publisher":90,"fileFormat":93,"inLanguage":57,"description":61,"dateModified":94,"datePublished":95,"encodingFormat":93,"isAccessibleForFree":96,"interactionStatistic":97},"DigitalDocument",{"url":83,"@type":84,"width":85,"height":86},"https://docshare.wps.com/thumbnails/missing-immunization-form-norquest-college/287171.png","ImageObject",442,249,{"name":88,"@type":89},"Rhys","Person",{"url":68,"name":91,"@type":92},"DocShare","Organization","application/pdf","2026-09-27","2026-09-17",true,{"@type":98,"interactionType":99,"userInteractionCount":47},"InteractionCounter",{"@type":100},"ViewAction",{"@type":102,"mainEntity":103},"FAQPage",[104,110,114],{"name":105,"@type":106,"acceptedAnswer":107},"What documentation must be attached to the Missing Immunization Form?","Question",{"text":108,"@type":109},"Students must attach a doctor’s note that specifies which immunization cannot be obtained, the underlying medical condition, the expected duration of the exemption, and a statement regarding physical capability to attend clinical or work settings.","Answer",{"name":111,"@type":106,"acceptedAnswer":112},"Who will receive my medical information once I sign the consent section?",{"text":113,"@type":109},"The information is shared with the Centre for Growth & Harmony, the program area, the Faculty of Health and Community Studies Work-Integrated Learning Team, and external stakeholders such as Alberta Health Services and Covenant Health.",{"name":115,"@type":106,"acceptedAnswer":116},"What is the purpose of collecting this personal information?",{"text":117,"@type":109},"The information is collected under the Alberta Freedom of Information and Protection of Privacy Act to ensure all medical requirements are met prior to practicum placements and to facilitate the placement process with external agencies.","https://schema.org",{"og:url":78,"og:type":120,"og:title":59,"og:site_name":91,"og:description":61},"article",{"robots":122,"canonical":78},"index,follow",{"doc_id":124,"site_id":56},287171,1790144945,{"code":4,"msg":5,"data":127},{"doc_id":124,"user_id":128,"nickname":88,"user_avatar":129,"doc_module":9,"category_id":35,"category_name":36,"doc_title":59,"doc_description":61,"doc_content":130,"file_id":131,"file_url":132,"file_type":133,"file_size":134,"view_count":47,"is_deleted":4,"is_public":9,"is_downloadable":9,"audit_status":9,"page_count":9,"language":135,"language_code":57,"site_id":56,"html_lang":57,"table_of_contents":136,"faqs":137,"seo_title":138,"seo_description":61,"update_tm":139,"read_time":4},687207024643,"https://ap-avatar.wpscdn.com/davatar_3d24733baf745e90a7e4bdd5f77d97b2","Missing Immunization Form  \nStudent’s name:   Today’s date:  Student ID\\#  Program:   Practicum start date (if known):    \nIndicate which vaccine/health test you are unable to receive due to medical reason:  \nAttach a doctor’s note indicating the reason you are unable to receive the vaccine/health test:  \n( Must include which immunization cannot be obtained, medical condition, and if there is a duration of time associated and whether the student is physically able to attend clinical/work/school during this period) .  \nConsent:  \nI  hereby give consent to share my personal and medical information, including doctors note with the Centre for Growth & Harmony, program area, Faculty of Health and Community Studies Work-Integrated Learning Team as well as external stakeholders such as Alberta Health Services, Covenant Health and other agencies where practicum can take place.  \nSignature: Today’s date:   \n** Once your immunization exemption form has been submitted, you will be contacted by the Faculty of Health and Community  \nStudies Work-Integrated Learning Team directly. **  \nNurses comments:  \n\n|  |\n| --- |\n|  |\n\nThe personal information requested on this form is collected under the authority of section 33(c) of the Alberta Freedom of Information and Protection of Privacy Act and will be used to ensure the proper requirements are met before practicum placement. This personal information will be disclosed to the agency where your practicum will take place, to facilitate the practicum process. Questions about the collection, use, and disclosure of this personal information can be directed to the Manager, Wellness and Accessibility, 10215 108 Street NW, Edmonton, AB T5J 1L6, Tel 780.644.6158.","cbCaiiUQHHLnueBk","https://ap.wps.com/l/cbCaiiUQHHLnueBk","pdf",71597,"English","# Student Information\n# Exemption Details\n# Consent and Signature\n# Privacy Notice","[{\"question\":\"What documentation must be attached to the Missing Immunization Form?\",\"answer\":\"Students must attach a doctor’s note that specifies which immunization cannot be obtained, the underlying medical condition, the expected duration of the exemption, and a statement regarding physical capability to attend clinical or work settings.\"},{\"question\":\"Who will receive my medical information once I sign the consent section?\",\"answer\":\"The information is shared with the Centre for Growth \\u0026 Harmony, the program area, the Faculty of Health and Community Studies Work-Integrated Learning Team, and external stakeholders such as Alberta Health Services and Covenant Health.\"},{\"question\":\"What is the purpose of collecting this personal information?\",\"answer\":\"The information is collected under the Alberta Freedom of Information and Protection of Privacy Act to ensure all medical requirements are met prior to practicum placements and to facilitate the placement process with external agencies.\"}]","Missing Immunization Form - NorQuest College | PDF",1789631981]