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Get Whittier Hospital Medical Center Attestation Form - Exhibit C 2016-2024

D below are completed and up to date for each of the students who will be utilizing WHMC for their clinical rotation as listed below. Enter the date of completion in the appropriate column. Influenza Vaccination or declination Hepatitis B Vaccination or declination Immune by positive titer 2nd dose Varicella TDAP 1st dose Immune by positive titer 2nd dose 1st dose Tuberculosis 2 step Drug Screen Background Screen STUDENT/ INSTRUCTOR NAME Physical Mumps Measles Rubella ___________.

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