Research Associates (RA) Program in Emergency Medicine
St. Vincent's Medical Center, Bridgeport CT
Please download  SVMC - RA Program Immunization Requirements

  • have your health care provider complete this form

  • please be sure your health care provider knows that
  • either Varicella titer or documentation of a vaccination series is required
  • a history of chickenpox is not sufficient

  • PPD test for tuberculosis must be within the last 12 months

  • for Hepatitis B, there are three (3) options
  • Hepatitis B vaccination series is complete and a Hepatitis B surface antigen
    demonstrates a response  or
  • Hepatitis B vaccination series is in progress  or
  • Hepatitis B vaccination declination form is included  with the
    SVMC / Student Health Services / Student Immunization Requirements form

When you go for your drug testing,
please bring a copy of your completed SVMC - RA Program Immunization Requirements to one of St.
Vincent's Immediate Health Care centers for your health assessment and drug testing.

     Do
not send these records to the RA Program

Vaccination against seasonal and H1N1 influenza is highly recommended.
Immunization Records