Department of Nursing
3307 N. Broad Street
Philadelphia, PA 19140
215-707-4686 (P)
215-707-1599 (F)
www.Temple.edu/nursing
American Data Bank Information Sheet – Mandatory Compliances
Dear Returning Clinical Nursing Student,
In order to participate in clinical fieldwork, you are required to complete and update mandatory compliances on an annual basis
according to the guidelines set forth by our clinical partners. These compliances are important to protect students and patients.
Students who do not complete all the indicated requirements by the deadlines indicated will not be permitted to attend clinical.
To purchase your required American DataBank packages:
1. Login to your Complio account
2. In the top right corner click on “Place Order”
3. Select your Program of Study
4. Click “Load Packages”, then select package to be ordered:
Tracking Package
As a returning clinical student, DO NOT PURCHASE AN IMMUNIZATION AND COMPLIANCE TRACKING
PACKAGE. Instead, when your account is within 30 days of expiration, you will have the opportunity to EXTEND your
subscription. By extending the subscription, all of your documents and compliance dates will remain linked in your account
without interruption.
Screening Packages – Purchase during required dates
Package 1: Criminal Background Check, includes FBI Fingerprints. May be completed on main campus between 4/15-
5/31.
Package 3: Drug Screening Only (may purchase package on or after July 15
th
. Must get tested between 7/30-8/10. If
test is performed before 7/30, you will need to repeat it for your Spring semester.)
Additional compliances are also required and listed below. A copy of the necessary forms that must be completed and uploaded to
your Complio account are enclosed. Additional copies can also be found on American DataBank.
1. American Heart Association (AHA) Basic Life Support (BLS) Provider certification is the only CPR course that will be
accepted. The student must complete the course entitled BLS for the Healthcare Professional, which includes infant, child,
and adult care, as well as use of the AED. The AHA BLS card is renewed every 2 years.
2. Immunization record confirming a blood test (Quantiferon) to rule out TB, influenza vaccine, a physical, and proof of health
insurance.
3. Tdap (Tetanus, Diphtheria and Pertussis Vaccination (every 10 years).
4. Nursing Department Administrative Documentation – Due dates for Administrative Documentation will vary. More
information will be provided to you via email.
Note: Once you complete each requirement, you will see (a green circle with a white checkmark). If you see (a red circle
with a white x), this indicates you are “Not Compliant” and did not satisfy that requirement.
As a reminder, in order to be “Compliant” and clear to attend your clinical rotation you must have all of the requirements completed.
If you have any questions regarding your Complio Account and/or completing your requirements, please contact American DataBank
directly. A representative can be reached by dialing 1-800-200-0853 and are available Monday-Friday 8am-6pm MT (Denver). If
your questions are unable to be answered by American DataBank, please contact Andrea Darden via email ADarden@temple.edu.
Regards,
Department of Nursing
Temple University Returning Students Requirements Form
New BSN/DNP 1
American DataBank LLC www.templecompliance.com email: [email protected] phone: 800.200.0853 Revised: 2.18.2020
I hereby authorize the release of my medical records to American DataBank to meet the requirements set by Temple University. I do agree to let Temple
University share my information with the clinical facilities. I do this with the understanding that my personal information will not be disseminated for any
other purpose than those specified by my educational institution. By affixing my signature, I grant my full consent for the duration of my enrollment at
Temple. I am aware that I can revoke my consent, in writing, at any time.
Student
Name
Signed Date
Student
Signature
Student ID
Number
**You must upload your documentation into your Complio account**
Immunization Requirements
This form must be signed/stamped and dated to be used in lieu of official documentation.
1
Tdap (Tetanus Diphtheria Pertussis) Due April 15-May 31
Required: Every Ten Years
Only Tdap is acceptable, no other type of Tetanus Vaccination will be accepted in lieu of the Tdap.
Tdap Vaccination Date: ____(m) ____(d) _____(y)
2
Quantiferon – Tuberculosis Gold Test (QFT-G)
Due April 15-May 31
Required: Annually
You must have a Quantiferon-TB Gold Test done on an annual basis. NOTE: No other type of TB testing will be accepted.
If any testing is positive, see TB Positive Section below.
Quantiferon®-TB Gold (QFT-G) Test Date: ____ (m) ____ (d) _____(y) Result? oNegative or o Positive
TB Positive (Newly Positive for TB): You must have a Chest X-Ray AND a letter from your healthcare provider outlining treatment
and when you may participate in clinicals.
Chest X-Ray Date: ____ (m) ____ (d) _____(y) Result? oNegative or o Positive
Known History of Positive TB: You must submit a letter from healthcare provider stating status of treatment and timeline for
clearance for clinical participation and results from your most recent Chest X-Ray.
TB Clearance Date: ____(m) ____(d) _____(y)
Required:
o Results from your most recent Chest X-Ray
o Copy of note from Healthcare Provider stating:
• Treatment situation
• ‘Not contagious for tuberculosis’
• Has been educated as to the symptoms and when to contact the
provider.
3
Influenza Vaccine (Flu Injection) Due Sept 1-Oct 15
Required: Annually
You must have a flu vaccine every year. Note: Vaccine is available by Temple University Student Health Services
Flu Shot Date: ____(m) ____(d) _____(y)
Healthcare Provider Information OR TU Student Health Information:
Provider Name (Printed): _________________________________________
Signature:_____________________________ Signed Date: ____________
Healthcare Provider Information (Signature/Stamp and Date):
Name: ___________________________________________ Title: _______________
Signature: ________________________________________ Stamp:
Signed Date: _________________
Temple University Returning Students Requirements Form
New BSN/DNP 2
American DataBank LLC www.templecompliance.com email: [email protected] phone: 800.200.0853 Revised: 2.18.2020
I hereby authorize the release of my medical records to American DataBank to meet the requirements set by Temple University. I do agree to let Temple
University share my information with the clinical facilities. I do this with the understanding that my personal information will not be disseminated for any
other purpose than those specified by my educational institution. By affixing my signature, I grant my full consent for the duration of my enrollment at
Temple. I am aware that I can revoke my consent, in writing, at any time.
Student
Name
Signed Date
Student
Signature
Student ID
Number
**You must upload your documentation into your Complio account**
Annual Physical Exam
This form must be signed/stamped and dated
4
Physical Exam Due April 15-May 31
Required: Annually
Must have a physical examination completed each year and have healthcare provider complete the section below.
NOTE: This form must be completed for Physical Exam. No other forms will be accepted.
Based on my examination, ___________________________________ is physically and psychologically able to be in a nursing care
setting and does not pose a significant health risk to him/her or to clients with whom he/she may come into contact:
o Agree
o Disagree
ß
If you disagree, (i.e. the person does pose a health risk to self or others) please explain:
Physical Exam Date: ____(m) ____(d) _____(y)
Healthcare Provider Information (Signature/Stamp and Date):
Name: _________________________ License Number: _______________
Signature: ______________________ Stamp:
Name/Address of Facility:
_______________________________
_______________________________
Signed Date: _________________
Temple University Returning Students Requirements Form
New BSN/DNP 3
American DataBank LLC www.templecompliance.com email: [email protected] phone: 800.200.0853 Revised: 2.18.2020
I hereby authorize the release of my medical records to American DataBank to meet the requirements set by Temple University. I do agree to let Temple
University share my information with the clinical facilities. I do this with the understanding that my personal information will not be disseminated for any other
purpose than those specified by my educational institution. By affixing my signature, I grant my full consent for the duration of my enrollment at Temple. I am
aware that I can revoke my consent, in writing, at any time.
Student
Name
Signed Date
Student
Signature
Student ID
Number
**You must upload your documentation into your Complio account**
Other Requirements
This form must be completed and verifying documents uploaded to your Complio Account.
5
CPR Card by American Heart Association Due April 15-May 31
Required: Every Two Years
Only AHA BLS for the Healthcare Professional CPR is acceptable. See www.heart.org to register and for information on classes.
Students: CPR must be valid for the academic year (August-April). If your CPR Card expires any time before May 1
st
, you will need to
renew your CPR prior to expiration so it does not expire during the academic school year.
AHA BLS Certification Date: ____(m) ____(d) _____(y)
Required:
o Copy of FRONT and BACK of AHA CPR Card
OR
o Copy eCard, Please also list eCard #__________________________
6
Health Insurance Card and Health Insurance Coverage
Verification – These items can be satisfied by uploading a copy of the front and back
of your current insurance card and providing your electronic signature in Complio.
Due April 15-May 31
Required: Annually
You must be covered by a health insurance policy such as Medicaid, a managed-care plan (such as Health Partners), an HMO or private
carrier (such as Blue Cross/Blue Shield).
Temple University Returning Students Requirements Form
New BSN/DNP 4
American DataBank LLC www.templecompliance.com email: [email protected] phone: 800.200.0853 Revised: 2.18.2020
I hereby authorize the release of my medical records to American DataBank to meet the requirements set by Temple University. I do agree to let Temple
University share my information with the clinical facilities. I do this with the understanding that my personal information will not be disseminated for any
other purpose than those specified by my educational institution. By affixing my signature, I grant my full consent for the duration of my enrollment at
Temple. I am aware that I can revoke my consent, in writing, at any time.
Student
Name
Signed Date
Student
Signature
Student ID
Number
**You must upload your documentation into your Complio account**
Background Check Requirements
This form must be completed & verifying documents uploaded to your Complio Account.
7
FBI Fingerprinting Due April 15-May 31
Required: Annually
You must complete your FBI Fingerprinting annually by June 1st. You will receive a copy of your results in the mail. Once results are
received, usually within 4-6 weeks, you must upload to your Complio Account. To track the status of results contact the PA Dept. of
Human Services 877.371.5422 option 4, option 1.
Search Complete Date: ____(m) ____(d) _____(y)
Required:
o Copy of FBI Fingerprinting Results
Arrest Record Found: o Yes o No
8
Child Abuse Clearance Due April 15-May 31
Required: Annually
You must complete your Child Abuse Clearance annually by June 1
st
. It is recommended that you request your child abuse clearance
results via online at www.compass.state.pa.us/cwis/public/home. Please visit www.TempleCompliance.com for more information
regarding the ordering process. (NOTE: By providing your SS# in APPLICANT INFORMATION section, results are usually obtained within
(1) hour.)
Once you receive your results, via email link, you must upload to your Complio Account.
Search Complete Date: ____(m) ____(d) _____(y)
Required:
o Copy of Child Abuse Clearance Results
Record Found: o Yes o No
9
Drug Screening Complete Between July 30-August 10
Required: Annually
You may purchase your drug screening package as early as 7/15 to allow time to schedule your appointment. But, you must
complete your Drug Screening between July 30
th
and August 10
th
to be compliant for the academic year. Visit
www.TempleCompliance.com for more information regarding the ordering process.
Results are reported directly to American DataBank 1 to 3 business days after test date.
Test Date: ____(m) ____(d) _____(y)
Temple University Returning Students Requirements Form
New BSN/DNP 5
American DataBank LLC www.templecompliance.com email: [email protected] phone: 800.200.0853 Revised: 2.18.2020
DNP STUDENTS ONLY:
I hereby authorize the release of my medical records to American DataBank to meet the requirements set by Temple University. I do agree to let Temple
University share my information with the clinical facilities. I do this with the understanding that my personal information will not be disseminated for any
other purpose than those specified by my educational institution. By affixing my signature, I grant my full consent for the duration of my enrollment at
Temple. I am aware that I can revoke my consent, in writing, at any time.
Student
Name
Signed Date
Student
Signature
Student ID
Number
**You must upload your documentation into your Complio account**
DNP Other Requirements
This form must be completed and verifying documents uploaded to your Complio Account.
10
RN Licenses Due April 15-May 31
Required: Every Two Years
Must have a Pennsylvania RN License and must be current at all times. Any other state RN License is optional and should be uploaded
into Complio.
11
CV/Resume Due April 15-May 31
Required: Annually
Resumes are reviewed by preceptors to determine whether they will accept a student. If needed, please visit Temple Career Center
for assistance in creating a resume https://www.temple.edu/provost/careercenter/resume/build.html.
Must upload an updated copy of your professional CV/Resume annually
