School of PHYSIOTHERAPY
Fax: 08 9433 0556
Immunisation Requirements for Physiotherapy Students in Clinical Environments
To Be Completed by end Semester 1, Year 1
Student Name
Student ID
Contact Phone/s
Mobile
Date of Birth
As a legal requirement from both the University and the clinical facilities in which the students will be having clinical contact,
they are required to supply documentation to confirm that they have been vaccinated and are immune to the following
pathologies. As clinical contact can start as soon as the inter-semester break of Year 1 students need to have their
immunisation well advanced by end of Semester 1, of Year 1.
Notre Dame recommends that you use your own GP or The Travel Doctor, Fremantle, 85 South Street (corner Solomon Street)
[email protected] Ph: 08 9336 6630] to show immunity for:
Confirmation of
Immunity/Vaccination
provided by Student 
Confirmation provided by Doctor 


b) *Diphtheria, Tetanus,
Pertussis


c)
d) *Hepatitis B


 1st injection  2nd injection
 1st injection  2nd  3rd  Serology
a) *Measles, Mumps,
Rubella
(MMR vaccine)
(DTP vaccine)
*Varicella (Chicken Pox)
Screening
e) TB - vaccination not
f)
required
MRSA Screening (if
indicated, see page 2)
Confirmation provided by Doctor 


Tests are available through the Travel Doctor Fremantle or your own GP
Students who have contraindications to receive any of the above vaccines must provide a Doctor’s Certificate.
Doctor’s Signature & Declaration
“I have met with _______________________________________ [student name] and am able to confirm
above records.
Name _______________________________________________
SIGNATURE:
School of Physiotherapy Immunisation Record 2014
DATE:
/
/ 20
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Advice for the Medical Practitioner
If the student has no confirmation of the required vaccinations, please arrange the following serologies:
• Measles
• Mumps
• Rubella1
• Varicella2
• Hepatitis B (if history of prior vaccination or exposure)
On the return visit, please vaccinate the student for any of the above for which there is no
documentation immunity, as well as DTP/ “Boostrix”
I.
Use the standard 3 dose, 6 month Hep B schedule and confirm seroconversion 1 month
after the 3rd dose.
MRSA screening is only required for students that have worked in or been a patient in a hospital or
worked in a residential care institution outside WA in the last 12 months.
It is performed by swabbing
 2 web spaced on each hand
 Wrist creases
 Both nostrils
 Any sores
with a dampened cotton swab.
(NB Medicare does not cover the cost of MRSA screening)
If you have any queries, please call:
School of Physiotherapy on 08 9433 0229
1.
2.
It is not unusual for women to be properly vaccinated for Rubella but have low levels of immunity. If a student has a
low level of immunity to Rubella despite a recent booster, this will be accepted without requirement for further
vaccination or blood testing.
Vaccination with 2 doses of vaccine may not produce a positive blood text but is effective in confirming immunity.
Hence students with an initial negative blood test for Chickenpox will need to provide proof of 2 subsequent
vaccinations but will not require a repeat blood test.
School of Physiotherapy Immunisation Record 2014
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