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Submit Health Testing Checklist & Evidence of Immunizations

We require the following tests and vaccines for regulatory compliance and to ensure immunity status, which is an essential part of our disease and infection prevention programs.

Vaccinations may be obtained from Samaritan Occupational Medicine or a facility of your choice. The expense is the responsibility of the student. If you decide not to receive the required vaccines, you may have your experience suspended or revoked.


TB Screening

Confirmation of a Tuberculosis (TB) Test is required. If you have no record of a Tuberculosis (TB) Test, you will need to have one taken and read at Samaritan Occupational Medicine (SOM) or the facility of your choice. If you’ve had a positive TB test in the past, you will need to complete a TB Risk Factor Screening form and chest x-ray or provide the Student Services Coordinator with a record of a chest x-ray dated within the last 6 months.

Measles (Rubeola), Mumps & Rubella

Please provide one of the following as evidence of MMR immunity:

  • Two MMR vaccines OR
  • Two Measles (Rubeola), two Mumps and one Rubella vaccine OR
  • Laboratory evidence of Measles, Mumps and Rubella immunity (titer)

Hepatitis B

Please provide one of the following as evidence of Hepatitis B (HBV) immunity:

  • Three Hepatitis B vaccines OR
  • Laboratory evidence of Hepatitis B immunity (titer)

Varicella (Chicken Pox)

Please provide one of the following as evidence of Varicella immunity:

  • Two Varicella vaccines OR
  • If you had Chicken Pox as a child, provide laboratory evidence of Varicella immunity (titer)


Influenza is a serious disease that can lead to hospitalization and sometimes even death. Students should receive an annual dose of the seasonal flu vaccine to prevent disease transmission.


Please provide evidence of a single dose of the Tetanus, Diphtheria and Pertussis (Tdap) vaccine within the last 10 years.


Please provide evidence indicating you have successfully completed a CDC recommended vaccination series for COVID-19 or select “declined COVID-19 vaccination” on the health testing checklist.


Definition of Healthcare Personnel (HCP)

HCP refers to all paid and unpaid persons working in a healthcare setting who have the potential for exposure to patients and/or to infectious materials, including body substances, contaminated medical supplies and equipment, contaminated environmental surfaces or contaminated air. HCP includes persons directly or indirectly involved in patient care who can be potentially exposed to infectious agents that can be transmitted to and from HCP and patients. These requirements apply to HCP working in (but not limited to) the following settings: acute care hospitals, nursing homes, skilled nursing facilities, physician’s offices, urgent care centers, outpatient clinics, and to persons who provide home health care and emergency medical services.

Definition of Titer

A titer is a laboratory test that measures the level of antibodies in a blood sample to determine immunity. 

It is the responsibility of the student to have required tests and immunizations completed prior to the first day of rotation.

Documentation is required and must be attached for all tests and immunizations.

Possible acceptable documentation may come from electronic medical records or the Oregon Alert System. School health records marked ’outside/unknown provider’ will not be accepted. If you do not have vaccination records, you may seek out a health care provider to have titers completed for each of the immunity statuses.

We recommend compiling all necessary information and documentation prior to completing and emailing the Health Testing Checklist Form and attachments.

Download and fill out the Health Testing Checklist. This checklist is required to be submitted with your evidence of immunizations. If you have had TB, please also complete and email the TB Risk Factor Screening form.

 Attach and email evidence of immunizations gathered in Step Two along with the Health Testing Checklist filled out in Step Three to Samaritan Health Services Student Services.

Frequently Asked Questions

Please contact your medical provider. They may give you a copy from their records or from the state immunization information system. You may also request a copy of your records directly from the Oregon ALERT Immunization Information system.

If you are unsure about your immunity status and are unable to locate records for one or more of the items listed within the Health Testing Checklist, speak with your medical provider about updating your vaccines and/or requesting a titer for proof of immunity to a specific disease. 

We follow guidance from the Oregon Health Authority 409–030–0180 Immunization Standards which defines “Evidence of Immunization” as a statement signed and dated by a licensed practitioner who has within the scope of the practitioner’s license the authority to administer immunizations or a representative of the local health department certifying the immunizations the student has received
We follow Oregon Administrative Rules (OAR) and Centers for Disease Control and Prevention (CDC) guidelines for Healthcare Personnel available at Testing Health Care Workers | Testing & Diagnosis | TB | CDC.
Please contact a Samaritan Occupational Medicine office, or any provider of your choice, to schedule a screening.

Yes. We require both varicella vaccines.

We require current vaccination status.
Samaritan Health Services is currently requesting all students and faculty submit evidence if fully vaccinated against COVID-19.
No. Non-medical exemptions from immunizations are not allowed.