Observation and Career Shadowing Infectious Disease Summary Completion Guidelines

Observation and Career Shadowing Infectious Disease Summary Completion Guidelines

The following information will help you fill out the Infectious Disease Summary required for observation and shadowing participants in clinical areas. The full application forms packet is available here.

Completing the Top Portion of the IDS

  • Provide ALL requested information in the top portion of the form (name, contact information, school/college/university affiliation, etc.).
  • Send your completed form to the department coordinator where you plan to observe, not to Penn State Health Milton S. Hershey Medical Center Employee Health.
  • Use the current IDS form found here only. Older versions will be rejected.
  • Do not send attachments to the IDS; the IDS must be completed in its entirety.

Completing the Bottom Portion of the IDS

This section must include all of the following:

  • Demonstration of a current tuberculosis exposure status (within one year of visit) by either:
    • Mantoux test (two-step if no documented skin test within previous 12 calendar months); or
    • blood TB interferon assay.
  • If known positive tuberculin skin test or TB interferon assay:
    • documentation of chest X-Ray (within one year of visit); or
    • demonstrating absence of disease; or
    • documentation of having received Isoniazid Prophylaxis Therapy.
    Note: Two-step is a Mantoux test for TB (PPD) where an individual receives one PPD and 10 to 21 days later, receives a second PPD. If an individual receives yearly PPDs, the person only needs to submit the two most current PPDs, as long as the most current one is within one year of the scheduled visit to Penn State Health Milton S. Hershey Medical Center/Penn State College of Medicine.
  • Documentation of immunity to rubeola, rubella, and mumps by either:
    • individual vaccines for each; or
    • two MMRs OR titers.
  • Documentation of immunity to varicella by either two vaccines or a positive titer, but not both.
  • Date of last TDAP.
  • Date of flu vaccine (required only during flu season, generally from October to March, but not after flu season is officially declared over).

Please note that Hepatitis B is not mandated, but it is recommended.

This form must be submitted one month prior to the start date of the observation.