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This document is a checklist of health care requirements for medical trainees at King Saud Medical City in Riyadh, Saudi Arabia. It requires prospective trainees to provide documentation of immunity to various diseases prior to training. This includes proof of immunity to hepatitis B and varicella through antibody titers or vaccination. The checklist also requires tuberculosis, hepatitis B, HIV, and other screening test results. Officials from the trainee's original medical facility must complete and sign the form.

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Mohammed Elhashimi
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72 views

Chick List

This document is a checklist of health care requirements for medical trainees at King Saud Medical City in Riyadh, Saudi Arabia. It requires prospective trainees to provide documentation of immunity to various diseases prior to training. This includes proof of immunity to hepatitis B and varicella through antibody titers or vaccination. The checklist also requires tuberculosis, hepatitis B, HIV, and other screening test results. Officials from the trainee's original medical facility must complete and sign the form.

Uploaded by

Mohammed Elhashimi
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
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Ministry of Health ~I.)jj


King Saud Medical City i4.!bl1 'g.r.w dllllllLJ,jlll
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Checklist of Health Care Requirements for Medical Trainees


All prospective medical trainees irrespective of duration of rotation at King Saud Medical City KSMC, Riyadh have to get
this form completed by their original medical facility. Proof of immunity against Hepatitis B and Varicella is mandatory
prior to commencing training.

Name of Applicant: Sponsoring institution:

Proposed training area: Duration of Period:

Private SectorD Government SecorD


Result Remarks
Tuberculin Skin Test
(TST) Result in millimeters o Positive o Negative
Chest Radiograph (lfTST is more than 10 mm)
attach report
OFFICIAL
Doctor's Name: Signature: Date: I I STAMP

Hepatitis B antibody titer


IF non immune, to be given hepatitis B
vaccine 3 doses then to repeat the titer (attach
o Immune
0 Non-Immune
documentation)
Hepatitis B surface antigen
(attach documentation) 0 Positive 0 Negative
Anti Hev antibody (attach documentation)
0 Positive 0 Negative
Varicella zoster antibody,
if non immune, to be given two doses
Varicella zoster vaccine 0 Immune 0 Non-Immune
(attach documentation)
Rubella Antibody (attach documentation)or a
documented proof of vaccination 0 Immune 0 Non-Immune
Mumps Antibody (attach documentation)or a
documented proof of vaccination 0 Immune 0 Non-Immune
Measles Antibody (attach documentation)or a
documented proof of vaccination 0 Immune 0 Non-Immune
HIV Antibody (attach documentation)
0 Positive 0 Negative

Doctor's Name: Signature: Date: I I OFFICIAL


STAMP

FitO untit 0 OFFICIAL


STAMP
Doctor's Name: Signature: Date: I I

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