Welcome to Complio Tracking & Screening!
Complio is an online tracking and screening system selected by FIU HWCOM to hold background check details and
documentation proving your compliance. Follow these step-by-step instructions to create an account and move towards
compliance.
Video: Complio Overview
http://www.americandatabank.com/VideoDirectory/complio_overview.html
Create your Account
Step 1: Create an account by going to http://fiumedicinescreening.com/. Navigate to the Complio homepage by following the
prompts on the page. Click Create an Account to get started. Enter your personal information. Be extra careful entering your
Email Address, as this is the system’s main mode of communication with you.
Video: Creating an Account
http://www.americandatabank.com/VideoDirectory/account.html
Step 2: Complio will send an email to the address used during account creation. Click on the Activation Link within the message
or copy and paste the URL in your web browser.
Place your Order
Step 3: Please note: An Account is not the same as a placing an order or subscribing for tracking your immunizations. Click Get
Started to begin placing your order. Select whether you are getting your fingerprints rolled in or outside Florida and your year
and click Load Packages. Select Tracking Package for $30 and Screening Packages: Level II Comprehensive Criminal Check for
$98 and Drug Screening for $42.
Video: Subscribe to Complio
http://www.americandatabank.com/VideoDirectory/subscribe.html
Step 4: Other names– Provide any alias/maiden names that you have used and click “Next” to continue.
Drug Screen Registration- (If your package does not include, please skip this step)
Step 5: Drug Screen Location – Select the drug screen location that is most convenient for you. The current page loads based on
the zip code of your current address, you can provide a different zip code to view additional locations. Once you register for a
location please use that location, if you have any questions or would like a different location please contact American DataBank
for assistance.
Upon completion of your order, you will receive an email with the registration and collection location you have chosen along
with detailed instructions on how to complete this portion of your background check. Please note: If you pay for your order by
money order you will not receive this information until the payment has been received. Make sure to either print out the
electronic drug screen registration form or just write down the registration ID and go to the collection site you selected along
with a photo ID to submit a specimen.
Important: DO NOT drink more than 8 oz. of fluid in the 2 hours prior to giving a urine sample. An abundance of fluid may result
in a “dilute” reading, which constitutes a “flagged” situation. It will keep you from attending clinical and requires immediate repayment and re-testing. At the facility, if you are not able to produce a urine sample when requested, call American DataBank at
1-800-200-0853 on how to proceed.
You MUST complete your drug screening within 30 days of ordering. If you do not get your drug screening done within 30 days,
YOU WILL BE REQUIRED TO ORDER AND PAY FOR A NEW DRUG SCREENING.
Electronic Signature
Step 6: Please read the Disclosure and Authorization on the next screen, sign, and click Accept & Proceed to continue.
Video: Signing Forms
http://www.americandatabank.com/VideoDirectory/SigningForms.html
Review and Confirmation
Step 7: Carefully review the information you have provided, once the order has been placed you cannot change any
information. If any information is incorrect you will be required to re-order at your own expense.
Step 8: Confirmation and Receipt - Once you have confirmed that your information is correct, please select payment of Credit
Card or Money Order. You will receive a receipt via email to your email address included with your order.
FBI Fingerprints- FL VECHS (Only if you selected In Florida)
Once you have placed your order, we will email you a packet containing your FL VECHS Fingerprints to instruct you on how to
register for an appointment and get your fingerprints rolled. Your school will receive the results within 2-3 weeks after they have
received your cards. Make sure to check your junk and spam folders.
FL VECHS Fingerprints- Non-Resident (Only if you selected Outside Florida)
Once you have placed your order, we will mail you a packet containing your FL VECHS Fingerprint to instruct you on how to
register, get your fingerprints rolled, and where to mail your cards for a non-resident. Please go to
http://www.myfbireport.com/locations/index.php to find a location within your state that may be able to roll your fingerprints.
Your school will receive the results within 2-3 weeks after they have received your cards.
Immunization Details & Documents
Step 9: Click Upload Documents and use the Browse button to locate documents within your computer. Detailed instructions
for document upload are provided in the full User Guide. You will need to upload all 5 documents in this packet and your health
insurance card. You must scan documents. Photos of documents will not be accepted.
Video: Upload Documents
http://www.americandatabank.com/VideoDirectory/upload.html
Step 10: Click Enter Requirement to add details for a specific requirement. There may be multiple options, but you may not
need to complete them all. Refer to the Note for explanation of options.
Video: Entering Data
http://www.americandatabank.com/VideoDirectory/data.html
Step 11: Select a Requirement, complete the required fields and select from the drop-down list of documents you’ve uploaded.
Click Submit to save what you’ve entered. You can Update the item at any time before it is approved.
Video: Exceptions - When and How to Apply
http://www.americandatabank.com/VideoDirectory/exceptions.html
Wait for Approval At this time, the requirement is pending review and approval by an Administrator. American DataBank
verifies items within 1-3 business day (excluding holidays and weekend).
Monitor Your Status We recommend checking Complio regularly. You are not fully compliant until your Overall Compliance
Status = Compliant, indicated with a Green Checkmark. Complio will notify you via email when your compliance status changes,
if an item is approaching expiration/deadline, or if a new requirement is added.
Questions? American DataBank is available to assist you Monday-Friday 7am-6pm MST or you can contact us by email
[email protected] or by calling 1-800-200-0853.
Immunization Documentation Form
Name: ____________________________________________________________ Sex: Male  Female  Date of Birth ______/_____/_____
Email: ________________________________________________________ Day-time phone or cell: _______________________
Vaccine and Immunity Verification (to be completed by health care provider):
For Hepatitis B & Varicella: Copies of your actual lab test results indicating positive serum antibody titers are required as proof of immunity.
When vaccine series is incomplete, the dates of vaccination should be provided on this form until the time when the serum antibody titers are
done to prove vaccine-induced immunity.
Dates vaccine administered (month/day/year)
Attach required documents
Vaccine / Test
Antibody titer results and date(s):
MMR (Measles, Mumps, Rubella)
•
(2 MMR vaccine doses required after 12 months of
____/_____/____
____/_____/____
Rubella: _________________
age OR serologic documentation of IgG antibody
Rubeola (Measles): __________
titers for all three viruses)
Mumps: _________________
Hepatitis B (primary series)
(3 dose vaccine series required AND serologic
____/____/____
documentation of positive Hepatitis B surface
____/____/____
(1 month after first
vaccine)
____/____/____
(6 months after first
vaccine)
Serologic titer result (date) REQUIRED:
Hepatitis B Surface Antibody titer (IgG
quantitative) positive
antibody titer (IgG quantitative)
_______________________
Hepatitis B (second series)
2 titer result (date) REQUIRED:
(This series of three vaccines and antibody titer are
nd
____/____/____
required only if Hep B Surface antibody titer is
____/____/____
(1 month after first
vaccine)
____/____/____
(6 months after first
vaccine)
Tetanus / Diphtheria / acellular Pertussis
N/A
____/_____/____
(Provide documentation of Td (Tetanus/diphtheria)booster within
last 2 years; if Td was received more than 2 years ago, then Tdap is
required)
Polio (4 doses required or positive antibody titer)
quantitative) positive
_______________________
negative after completing the first series)
(Tdap)
Hepatitis B Surface Antibody titer (IgG
___/____/____
___/____/____
___/____/___
___/____/___
Serologic titer required if dates of all 4
polio doses is not completed.
Titer result/date: _____________
Varicella (Chicken Pox)
(2 vaccine doses given 4-8 weeks apart AND
____/_____/____
positive Varicella serologic IgG titer)
____/_____/____
(1-2 months after first vaccine)
Varicella IgG titer result and date
REQUIRED
_______________________
N/A
Meningitis (Meningococcal)
(one dose, required)
2-Step Tuberculosis Skin Test (PPD)
(chest x-ray required if PPD is +)
____/_____/____
If + PPD: Need chest X-ray results within
____/_____/____
____/_____/____
(to be done 1-2 weeks after
first skin test)
past 12 months and written clearance from
MD (signature on TB Screening Form).
Physician Attestation Statement: This section must be completed and signed. Based on the above immunization documentation, this
student is cleared to participate in all aspects of a medical school education, including direct patient contact:
 Yes  No  Yes temporarily, pending completion of the following recommendations pertaining to immunity status:
Recommendations (vaccines/ titers still needed with dates of required completion): _______________________________________
________________________________________________________________________________________________
Physician’s Signature: _____________________________________________________
Printed Name of Physician: _________________________________ Date: _________
Office Phone: ___________________________________________________________
Office Address: _________________________________________________________
OFFICE STAMP (REQUIRED)
Upload this document to your American DataBank Complio online account.
Medical History and Physical Examination Form
Name: _____________________________________________________________ Panther ID #: ________________________
(PRINT -- Last, First, Middle)
Sex: Male 
Female 
Date of Birth _____/_____/______ Age: ______ Email: ____________________________________
(Month)
(Day)
(Year)
Cell Phone: ________________________________
Home Phone: ________________________________
Local Address: ________________________________________________________________________________________________
Street
Apartment
City
State
Zip
Emergency Contact: __________________________________________ Relationship to you: ________________________________
Phone: ___________________________ Address: ___________________________________________________________________
*******************************************************************************************************************************************************************************************
ALLERGIES:
 No known allergies
 Penicillin  Aspirin  Sulfa
 Codeine  Other drugs: ______________  Food: _____________
PERSONAL HISTORY:
Chronic medical conditions and diagnoses:
___________________________________________________________________________________________________
___________________________________________________________________________________________________
HEIGHT: __________
WEIGHT: __________
B/P: _____________
T: __________ P: __________
VISUAL ACUITY (best corrected): (R) 20/_____ (L) 20/_____
PHYSICAL EXAMINATION: Date of exam:
Normal:
/
YES
/______
NO*
Normal:
Appearance, skin
Abdomen, pelvis
Eyes
Neurological
Ears, nose, throat, neck
Ortho, spine, extremities
Lungs
Mental Health
Heart, pulses
Other:
YES
NO*
* Abnormal Findings: __________________________________________________________________________________________
____________________________________________________________________________________________________________
*******************************************************************************************************************************************************************************************
PHYSICIAN ATTESTATION STATEMENT (must be completed and signed): Based on medical history and my physical examination, this
student is cleared to participate in all aspects of a medical school education.
 Yes
 No
 Yes, pending ____________________________________________________________________
_______________________________________________________________________________________________________
_______________________________________________________________________________________________________
Physician’s Signature: _________________________________________________________
OFFICE STAMP (REQUIRED)
Printed Name of Physician: _____________________________________ Date: __________
Office Phone: _________________________
Office Address: ______________________________________________________________________________________
Upload this document to your American DataBank Complio online account.
Health Insurance Verification Form
PART A: Student Information
Name: ________________________________________________
Sex:
Male
Female
Date of Birth ______/_____/______
(Month)
(Day)
(Year)
 Do you plan to enroll in the FIU Student Health insurance plan?
Yes
No
If YES, proceed to Part C below. You will be required to upload proof to Complio once you receive your insurance card.
If NO, please complete Parts B & C below.
-------------------------------------------------------------------------------------------------------------------------------------------------------PART B: Insurance Policy Information
Name of Insurance Company: _________________________________________________________________
Policy #: _____________________________________
Group #: _______________________________
Type of Insurance:
PPO
HMO
Indemnity
Other
Unknown
Effective Date: ________________________
End Date (unless renewed): __________________
Name of Insured or policy holder: ___________________________ Relationship to student: _______________
---------------------------------------------------------------------------------------------------------------------------------------------------------------Part C: Verification and Statement of Financial Responsibility
 Verification of your insurance coverage may be made by one of the following ways:
Photocopy of valid insurance card (Upload/scan the front and back of this document to your American
DataBank Complio account AND this form).
Photocopy of your insurance policy summary sheet that demonstrates uninterrupted coverage for an entire year
(Upload this proof to your American DataBank account with this form).
 I, ____________________________________________, hereby certify that I am personally covered by health
insurance or an equivalent health care plan as required by Florida International University (FIU) Herbert Wertheim
College of Medicine (HWCOM). If the HWCOM determines that the above coverage does not comply with the basic
health insurance requirement, I understand and agree that the HWCOM may charge my University account for
health insurance coverage, and I agree to pay all such charges in accordance with University policy. I understand and
agree that I will be responsible for any and all charges for health care services regardless of whether or not covered
by insurance or equivalent plan. I further understand and agree that the FIU HWCOM and all of its representatives
will not be responsible for paying for or providing any medical/hospital care or health insurance coverage for me.
The above information is requested for the purpose of compliance with the health insurance requirement for
HWCOM students. The information will only be used by the Office of Student Affairs for the purpose of identifying
and evaluating health care financial responsibility information in accordance with established requirements and will
not be released to any party outside the HWCOM without my written permission, except as permitted by law.
I understand and agree that I must complete this form at the start of each academic year and whenever my health
insurance coverage changes for any reason.
Signature:_______________________________
Panther ID #:_______________________
Date:_____________________________
Upload this document to your American DataBank Complio online account.
Health and Safety Agreement
I agree to fulfill and provide documentation of all health and safety requirements listed below. All Pre-Matriculation
forms (e.g., the “Medical History and Physical Examination” form, “Health Insurance Verification” form, the
“Immunization Documentation” form, and this form all must be uploaded directly to the American DataBank Complio
website for the FIU Herbert Wertheim College of Medicine (HWCOM). The OSA will receive notification from American
DataBank regarding my compliance status. If vaccine information or medical testing is incomplete, I agree to comply
with any requirements and submit documentation to American DataBank as soon as possible. All tests and at least the
first dose of all vaccine series must be done prior to Orientation. I also agree to comply with all annual and future
health requirements that may be subsequently prescribed by the FIU HWCOM designed to protect my health.
Ongoing Annual Health Requirements:
1. TB SCREENING: I agree to upload results of annual TB screenings to my American DataBank Complio site, as
follows: 1) If I’m PPD negative, I agree to submit an annual PPD skin test or Quantiferon Interferon-gamma release
assay blood test; 2) If I’m PPD positive, I will submit the results of a chest X-ray that was done shortly after the PPD
became positive and provide an annual TB Symptom Screening form signed by my physician.
2. DISABILITY INSURANCE: I agree to purchase the school’s designated Disability Insurance Policy during Orientation
and agree to renew it annually while enrolled as a student at the FIU HWCOM.
3. HEALTH INSURANCE: I will purchase and maintain a health insurance policy for the duration of my medical school
enrollment that meets the basic requirements of the FIU student health insurance plan designed for medical
students. I will not cancel this policy unless I provide proof of comparable coverage under an alternate acceptable
policy and upload a revised “Insurance Verification Form” and copies of the insurance card to my American
DataBank online account within seven days. I agree to complete and upload this form before August 1st annually
even if no changes to my health insurance have occurred.
4. INFLUENZA VACCINE: I agree to receive the seasonal influenza vaccine annually before October 31st, unless I have
medical contraindications documented by my personal physician. I agree to upload this documentation promptly to
my American DataBank online account.
I freely provide this information and understand that non-compliance will result in my inability to participate in clinical
activities until all requirements have been met. I also understand that this will negatively affect my academic
performance which may lead to dismissal from the FIU HWCOM.
Signature:_______________________________
Panther ID #:_______________________
Print Name: _____________________________
Date:_____________________________
Upload this document to your American DataBank Complio online account.
Tuberculosis Screening Questionnaire
(to be completed if student is PPD+)
Print Student Name: _______________________________________ Date: ________________
YES*
NO
YES*
NO
Has anyone in your family or other close contact had tuberculosis (TB)?
Have you ever been on medication to treat TB?
Have you ever had a BCTG vaccination? If yes, when? Date: ________________
Have you had any of the following symptoms in the past month?
Chronic cough (more than three weeks)
Fever/chills
Unexplained weight loss
Excessive fatigue or weakness daily
Spitting or coughing up blood
Night sweats
Loss of appetite
* Please explain any “Yes” responses below – continue on separate sheet if necessary.
_____________________________________________________________________________________________
_____________________________________________________________________________________________
The information I have provided in this form is accurate to the best of my knowledge. I acknowledge that the FIU
Herbert Wertheim College of Medicine is not responsible for any information I omit.
Student’s Signature: ____________________________________________ Date: _____________
----------------------------------------------------------------------------------------------------------------------------------------------------Physician’s Signature: _______________________________________
OFFICE STAMP (REQUIRED)
Print Physician Name: ___________________________________ Date: ________
Office Address: ________________________________________ Office Phone: _________________________
If your PPD test is positive, this form must be completed annually in lieu of receiving annual Chest X-rays.
Upload this document to your American DataBank Complio online account.