CON Request for Waiver of Faculty Immunizations or CPR Requirements: Difference between revisions
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<td width="60%">Section - Information</td> | <td width="60%">Section - Information</td> | ||
<td width="40%">Originating Date: October | <td width="40%">Originating Date: October 2003</td> | ||
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<td valign="top" width="60%">Responsible Reviewing Agency:<br /><div style="margin-left:3em; line-height:1.2;">Executive Council<br />Faculty Coordinating Council</div></td> | <td valign="top" width="60%">Responsible Reviewing Agency:<br /><div style="margin-left:3em; line-height:1.2;">Executive Council<br />Faculty Coordinating Council</div></td> | ||
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<td>Revised: February | <td>Revised: [[CON Request for Waiver of Faculty Immunizations or CPR Requirements version February 2008|February 2008]]<br />Reviewed: May 2016</td> | ||
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Revision as of 10:54, June 2, 2016
Home | Appendices |
UNIVERSITY OF NEBRASKA MEDICAL CENTER COLLEGE OF NURSING |
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Request for Waiver of Faculty Immunizations or CPR Requirements(Subsection 4.2.12 in Resource Manual) | Subsection: Appendix M | |
Section - Information | Originating Date: October 2003 | |
Responsible Reviewing Agency: Executive Council Faculty Coordinating Council |
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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:
for the following reason(s):
_______________________________________________ | _______________________________ | |
Faculty Signature | Date | |
_______________________________________________ | _______________________________ | |
Department Chair/Division Assistant Dean Signature | Date | |