CON Request for Waiver of Faculty Immunizations or CPR Requirements: Difference between revisions

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         <td width="60%"><big>'''Request for Waiver of Faculty Immunizations or CPR Requirements'''</big>(Subsection 4.2.12 in Resource Manual)</td>
         <td width="60%"><big>'''Request for Waiver of Faculty Immunizations or CPR Requirements'''</big></td>
         <td valign="top" width="40%"><big>Subsection: '''Appendix M'''</big></td>
         <td valign="top" width="40%"><big>Subsection: '''Appendix M'''</big></td>
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         <td width="60%">Section - Information</td>
         <td width="60%">Section - Appendices</td>
         <td width="40%">Originating Date: October 2003</td>
         <td width="40%">Originating Date: October 2003</td>
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                 <td>Revised: [[CON Request for Waiver of Faculty Immunizations or CPR Requirements version February 2008|February 2008]]<br />Reviewed: May 2016</td>
                 <td>Revised: [[CON Request for Waiver of Faculty Immunizations or CPR Requirements version February 2008|February 2008]]<br />Reviewed: [[CON Request for Waiver of Faculty Immunications or CPR Requirements version May 2016|May 2016]]<br />Revised: March 2018</td>
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     <td valign="top"><small>J:/RESOURCE MANUAL/Table of Contents College of Nursing Resource Manual</small></td>
     <td colspan="2" valign="top">Related documents:<br /><div style="margin-left:3em; line-height:1.2;">4.2.12</div></td>
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<p style="margin-bottom:150px; max-width:70em !important;">I, ________________________________________________, request a waiver of requirements for the following immunization(s) and or CPR, and include a signed statement from my primary care provider if for medical reasons:</p>
<p style="margin-bottom:150px; max-width:70em !important;">I, ________________________________________________, request a waiver of requirements for the following immunization(s) and/or CPR (please list):</p>
<p style="margin-bottom:150px;">for the following reason(s):</p>
<p style="margin-bottom:150px;">for the following reason(s) (ex. allergy):</p>
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<tr><td colspan="3">Submit completed/signed form to conrecords@unmc.edu</td></tr>
<tr><td colspan="3">&nbsp;</td></tr>
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<tr><td colspan="3">Note: For recurring requirements, form should be submitted each time requirements comes due.</td></tr>
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Latest revision as of 13:42, October 7, 2019

Home   Appendices                    


UNIVERSITY OF NEBRASKA MEDICAL CENTER
COLLEGE OF NURSING
Request for Waiver of Faculty Immunizations or CPR Requirements Subsection: Appendix M
Section - Appendices Originating Date: October 2003
Responsible Reviewing Agency:
Executive Council
Faculty Coordinating Council
Revised: February 2008
Reviewed: May 2016
Revised: March 2018
Related documents:
4.2.12


I, ________________________________________________, request a waiver of requirements for the following immunization(s) and/or CPR (please list):

for the following reason(s) (ex. allergy):

_______________________________________________   _______________________________
Faculty Signature   Date
 
Submit completed/signed form to conrecords@unmc.edu
 
Note: For recurring requirements, form should be submitted each time requirements comes due.