Required Document ( Please mail, email, or fax )
1. RN/CNA/LVN License
3. CEUs for RNs
5. Driver License
6. Social Security Card
7. Voided Check
1. *Physical Exam (Stated fit for duty: The Associate provider is physically able to do his/her job without accommodations and is free from communicable diseases.) ANNUAL
2. *PPD ANNUAL
a. *If positive for TB, Chest X-ray within 4 years must be accompanied by proof of past positive PPD or BCG Vaccine in any time frame.
3. TB Questionnaire -ANNUAL
4. Lab Drug Screen
5. Flu vaccine or declination – If declining, provider must wear a mask-ANNUAL
6. Mask Fit Test -ANNUAL
1. *Rubella- 2 Vaccines or a Positive IGG Titer
2. *Rubeola- 2 Vaccines or a Positive IGG Titer
3. *Mumps- 2 Vaccines or a Positive IGG Titer
4. *Varicella- 2 Vaccines or a Positive IGG Titer
5. *TDAP Vaccine within 10 years or Declination.
6. *HEP B- Completed 3 Series Vaccine or a Positive Titer
*All health documents must be signed and stamped by facility.