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Immunizations Required

Please use this document to keep track of your immunizations.

PPD- One in last 12 months, with written proof of Neg result.
- Date and time of both placement and read, title and results must include induration (size in mm=0), negative or positive result.
- For history of positive TST (≥10 mm) or a positive IGRA, must have documentation of a PA/Lat chest x-ray done within 6 months demonstrating no active tuberculosis.
MMR- Proof of vaccination or current immunity (titer) to rubella/rubeola/ mumps.
- Proof of 2 needed (at least 28 days apart) or positive titer.
Varicella (Chicken Pox)- Proof of vaccination or current immunity (titer) to varicella (chicken pox).
- Proof of 2 needed (at least 28 days apart) or positive titer.
Hepatitis B- Proof of immunity, past infection (titer) or a signed Hep B declination form.
- Proof of 3 needed (0, 1 mo., 6 mos.). If declines, must sign a declination form.
DTP (Tetanus-Diphtheria-Acellular Pertussis)- Proof of current vaccination or a signed tetanus-diphtheria-acellular pertussis vaccination declination form.
- Booster after age 11.
- Tetanus must be within the last 10 years.
- If declines, must sign declination.
Influenza- Proof of current vaccination or an Influenza vaccination declination form.
- During flu season (Sept-April).
- If declines, must wear mask at all times in patient areas.
COVID-19- Initial vaccine series (2 doses of Pfizer, 2 doses of Moderna, or 1 dose of Johnson & Johnson).
- No exemptions allowed.

Immunizations Records Submit to and Date:

Other Documentation

Please submit the documentation for the following items together in ONE pdf to Elizabeth Doty at, and Dr. Vikki Yu at[/email]

  1. Drug Test Results
  2. CPR Certification
  3. Background Check Results

Drug Test

  • Due SIX weeks prior to start date.
  • All students need to obtain a drug clearance via a urine test. If you have SHIP insurance, it is possible for you to have the drug testing done at the Tang Health Center. Please contact Dr. Harry Green ( to place an order for your drug testing. Your SHIP insurance will cover the cost of the drug testing, but there may be a copay.
  • Otherwise, Any SHIP student can make an apt at Tang in primary care and simply tell the clinician why they need the drug screen (urine test) it could be ordered for them. You might even be able to send a message to your primary care provider with this type of request. You can also ask the SHIP office/lab directly what the co-pays are for the tests.
  • Non-SHIP patients can do the same, as you are able to obtain services at Tang, but it will cost more. As an alternative, if you do not have SHIP insurance, please contact your primary care physician and to see if they can order a urine drug testing for you.
  • Please submit to Elizabeth Doty at,
    and Dr. Vikki Yu at

CPR Certification Requirement

Fingerprinting Protocol for Background Check

  • Due SIX weeks prior to start date.
  • Background Check. Results kept in Clinic Admin Office. Fingerprinting can only be done in any state. If it is done in the state of California, you will do the digital, electronic fingerprinting Live Scan process. If you are outside of California, you will have to have your fingerprints taken on hard copy fingerprint cards (not digital and electronic).
Step 1Use the School of Optometry fingerprinting link to schedule your appointment.
Step 2Enter all your personal information, following the prompts.
Important: You must use the legal name that matches the name on your government ID when scheduling your appointment.
Step 3 for CALIFORNIA Locations if you are doing the fingerprinting while in CaliforniaWhen in the state of California, you will be doing digital LIVESCAN for fingerprinting.Review all fingerprinting locations and make your appointment at a location that is most convenient for you and works best based on availability.
Step 3 for NON-CALIFORNIA Locations if you are doing the fingerprinting outside of the state of California

If this applies, you will complete two (2) “hard cards” for your fingerprints with ink instead of having them submitted electronically.

These instructions are also outlined on the scheduling website as you make your appointment.
When you are out of the state of California, you cannot do LIVESCAN fingerprinting. Instead, you must obtain and submit two hard-copy fingerprint cards done with ink.

  • Follow steps 1-2 as shown above.

  • Continue with the transaction by choosing Ink Fingerprint Processing Center.

  • Find the location in your city/state that is most convenient. The local Police Department Sheriff's Office, or UPS store may be an option or you can choose another location.

  • It is recommended that you call the location to ensure their fingerprinting services also include offering hard card processing.

  • You will need to pay fingerprinting fees (see fee structure below) using your credit card.

  • After choosing the location and paying the fee with your credit card, print out the Request Form (you will see this after the purchase/fee).

    • After attending your appointment: write the “Payment ID” on the top of both hard cards. This will be reflected on a confirmation email you will receive. It should also be reflected on the Request Form you are asked to print prior to your appointment.

    • Mail the Request Form along with BOTH completed fingerprint cards (a.k.a FD-258 cards) via a trackable service such as USPS Express Mail, UPS or FedEx to:

      Capital Live Scan
      ATTN: Ink Card Processing Center
      5706 Broadway, Sacramento, CA 95820

    Important: Be sure you DO NOT FOLD the hard cards across any fingerprints as it will interfere with processing. Your fingerprints will be submitted within 24 hours of receipt of the COMPLETE mail-in package.
Step 4Please complete ALL of the following three forms for your fingerprinting done at UCPD. If you do not provide UCPD with the forms, they will not know who to send the background check results to. Fax all forms as soon as you have completed your appointment and fax to UCPD at (510) 643-4655.

1. Request for Live Scan Service. Print one copy and complete section 3 - see sample (Request for Live Scan Service SAMPLE). The ORI number is CA0019700 which goes on the top left of the form. Be sure to make/ask for a copy of the form once it has been processed by the agent (the agent may write down some transaction numbers). Even a photograph of the form is acceptable. In the case that you have to re-do the fingerprints, the agency may need to refer to the original LiveScan form.
2. Release and Disclosure Form (The witness can be anyone in Clinic Administration, UCPD, or if the former are not possible, anyone).
3. Job Description for Optometric Interns.

UCPD will send the results of your background check to Clinic Admin only if you have faxed the three forms to them.

Documentation Required – Submit to Kaiser Sacramento

Documentation Submit to and Date

Complete the Preceptor Application, the User Agreement and the Student and Volunteer Attestation Form at least one month in advance and return it to:

Charina Mendenhall, Recruiter Phone (916) 486-5196
Fax (877) 632-8504

Send Copy to: Linda Vera

Absence Policy

  • Any leave must be requested at least 2 weeks in advance of the desired day off and be approved.  Requested leave will be granted at the discretion of the Clinical program coordinator. Absences not made up will be reported to UCBSO.
  • If you are sick and need to call in sick, please text and email your attending for that day. Make-ups in the form of additional Saturdays will be expected.
  • Any absences (personal days, illness) can be traded for a Saturday. Clinic is open Monday-Saturday, but standard student rotation days are Monday-Friday.

Allowed Absences (Not Requiring Make Up)

  • Residency interviews.
  • NBEO Parts I and 2: NBEO Parts I and 2: travel days are not approved for UCBSO students as these tests are offered locally.
  • NBEO Part 3: Please schedule the exam on a Monday or Friday. Travel days are allowed 1 day prior to and 1 day after the date of the Part 3 examination unless the test date falls on a Monday or Friday.  In which case there is no travel day allowed prior to the test if the test falls on a Monday and there is no travel day allowed after the test if the test falls on a Friday.