HPU Physical Examination and Immunization Form
This file is a comprehensive form used by Hawaii Pacific University for physical examinations, immunization records, and health reports required for their nursing program. It includes sections for immunization screens, health questionnaires, and physical examination forms with required certifications from healthcare providers. The form aims to ensure students meet the physical requirements necessary to participate in the nursing program.
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How do I fill this out?
To properly fill out the Hawaii Pacific University Physical Examination Form, start by completing the Immunization Record and Health Report section. Ensure that all positive screens/titers are attached with corresponding lab results. Proceed to the Health Questionnaire section to provide detailed information about your medical history and physical condition.
How to fill out the HPU Physical Examination and Immunization Form?
1
Complete the personal information at the top of the form.
2
Attach lab results for all positive screens/titers.
3
Fill out the Health Questionnaire, detailing any limitations or medications.
4
Have a healthcare provider complete and sign the Physical Examination Form.
5
Submit the signed form along with any supporting documents.
Who needs the HPU Physical Examination and Immunization Form?
1
Nursing students at Hawaii Pacific University need this form to meet program requirements.
2
Healthcare providers require this form to document and certify the physical fitness of nursing students.
3
University administrators use this form to verify immunization and health records.
4
Prospective nursing students must complete this form as part of their application process.
5
Current nursing students may need this form for periodic health assessments.
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What are the instructions for submitting this form?
Submit the completed form to the Hawaii Pacific University nursing program office. Forms can be submitted via email to nursing@hpu.edu, faxed to (808) 544-1131, or mailed to: Hawaii Pacific University, College of Health & Society, Nursing Program, 1 Aloha Tower Drive, Honolulu, HI 96813. Ensure all signatures and lab results are included. For questions, contact the nursing program office.
What are the important dates for this form in 2024 and 2025?
The form should be submitted before the start of the nursing program. Key dates for the 2024 and 2025 academic years include: initial submission by August 1st, annual updates by August 1st of each year following.
What is the purpose of this form?
The purpose of this form is to ensure that nursing students at Hawaii Pacific University meet the physical and immunization requirements necessary for participation in the nursing program. This includes documenting comprehensive health information, verifying immunization status, and obtaining certifications from healthcare providers. By completing this form, students and the university can ensure a safe and healthy learning environment.
Tell me about this form and its components and fields line-by-line.
- 1. Immunization Record: Documents immunization history and lab results for required screens/titers.
- 2. Health Questionnaire: Captures the student's medical history, physical limitations, and medications.
- 3. Physical Examination Form: Includes healthcare provider certification of the student's fitness for the nursing program.
- 4. Personal Information: Captures the student's name, HPU ID number, and other identifying details.
- 5. Signature Fields: Fields for signatures of the student and healthcare provider to certify the form.
What happens if I fail to submit this form?
Failure to submit this form may result in disqualification from the nursing program or delay in enrollment.
- Program Disqualification: Students may be disqualified from the nursing program if the form is not submitted on time.
- Enrollment Delays: Enrollment may be delayed until the required documentation is provided.
How do I know when to use this form?
- 1. Initial Enrollment: Required for initial enrollment in the nursing program.
- 2. Annual Updates: Used for annual updates to ensure continued compliance with program health requirements.
- 3. Health Assessments: Completed for periodic health assessments during the program.
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