Division of Health Sciences

Immunisation Screening and Vaccinations

for Entry to Health Sciences
Professional Programmes 2017
Rationale
See Infectious Diseases Policy for Students
You are required to have immunity to Hepatitis B, Measles, Mumps, Rubella and Varicella and be tested for Hepatitis C, HIV and
Tuberculosis (TB). If you lack sufficient immunity, you will require vaccinations.
In addition you must have had a booster vaccination for tetanus/diphtheria and pertussis (whooping cough within the last two years.)
If you do not complete or attend immunity screening/vaccination clinics this significantly increases your costs and may prevent
you from undertaking clinical components of your programme.

Procedure
You do NOT need a Doctor appointment to complete these tests
Fill in the laboratory form and take to a designated lab and have the required immunity blood tests before 23rd January 2017.
(We may not accept results from other labs.)
If you are unable to have these immunity tests done at home, please contact us as soon as possible.
Obtain a diphtheria/tetanus/pertussis booster and your vaccination record from your home Medical Centre Practice Nurse
Scan and email completed vaccination record to sh-vaxclinic@otago.ac.nz before 23rd January 2017.
If required, all other vaccinations will be given early in Semester One; you will be notified via student web mail of clinic dates and times.
** You must produce current photographic ID at the time of your tests/vaccination e.g. Passport, Drivers Licence, or Student ID.

Costs
Blood testing charges are set by the laboratories. For this programme we have negotiated a 10% discount.
Your Department contributes a $55 per-student subsidy. This covers the cost of planning, collation of results, recalls, nurse
administration of vaccines in arranged clinics and collation of final vaccination and immunity results.
Vaccine costs are paid per vaccine required; for more info otago.ac.nz/studenthealth/about/otago020527.html
Study-Link allows you to claim immunity screening and vaccination costs as course related costs.

Immunity Screening Blood Tests*

Quantiferon Gold (TB)

Hepatitis B ab and ag

$78.50
$43.00

Hepatitis C ab

HIV

$23.50
$21.50

Measles/Mumps/Rubella

$85.00

Varicella

$30.00

Blood Draw Fee

$12.00

Total $293.50
10% discount

$265.00

* At designated Laboratories; costs correct at time of publication.

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Results
Your immunity test results will be sent directly to Student Health by the lab, these results and your vaccination records
will be collated and filed at Student Health Services.
Your immunity screening results and vaccination status will be forwarded to your Professional School and you will be sent
a copy for your own records.
You will be informed of any abnormal results and if required, you will be referred as appropriate.
If you miss two consecutive recalls for screening or vaccination, your Head of Department will be informed.
Student Health Services contact for all queries: sh-vaxclinic@otago.ac.nz

Checklist
To be completed before 23 January 2017
Immunity screening completed at designated lab (or advise Student Health if unable to attend)
Obtained diphtheria/tetanus/pertussis vaccination and vaccination record.
Scanned and emailed your completed record to Student Health Services

Forms
Vaccination and Vaccination Record Form Page 4
Immunity Screening Lab request form Page 3
Designated Labs and contact details Pages 6-7

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University of Otago

Vaccination and Vaccination Record Form 2017

Diphtheria/tetanus/pertussis record (NB Vaccine must contain pertussis)

Last Name
First Name
DOB
NHI
Student ID number

Intended Course
Photographic ID checked** Yes
eg Medicine, Physio

Diphtheria/tetanus/pertussis
Batch
Expiry
Site

Name of Health Professional
Practice Stamp

Signature
Date

** Photographic ID must be current Passport, Drivers Licence, Student ID or other valid ID

Vaccination Record (previous vaccinations only)

Vaccination

Date

Vaccination

MMR 1

Pertussis 1

MMR 2

Pertussis 2

Hepatitis B 1

Pertussis 3

Hepatitis B 2

Polio 1

Hepatitis B 3

Polio 2

Tetanus 1

Polio 3

Tetanus 2

Other: eg Varicella

Date

Tetanus 3
Tetanus 4
Name of Health Professional
Practice Stamp

Signature
Date

If no vaccination record available please sign declaration below

I declare that to the best of my knowledge I have completed a full schedule of primary vaccinations
Student Name

Student Signature

Date

CONSENT
I consent to the release of my serology results and vaccination history to appropriate University of Otago staff of the Professional
Programme to which I am admitted, as evidence of complying with the Infectious Diseases Policy for Health Professional Students:
otago.ac.nz/healthsciences/otago078279.pdf
Student Name

Student Signature

Date

Please PDF and return via email by 23 January 2017 to: sh-vaxclinic@otago.ac.nz
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University of Otago

Health Sciences Screening 2017

Surname

Given Names

Address

Lab No

Date of Birth

Male

Female

PAYMENT MUST BE MADE AT TIME OF COLLECTION: $265 (INC)

Photo ID must be sighted:
Passport

Date of collect:

Drivers license

Time of collect:

Student ID card

Collected by:

Other

Collection Centre code:

LAB INSTRUCTIONS

LAB INSTRUCTIONS

Doctor code: GCSTU

Billing code: HSSM
Panel codes: Profile =HSSM


Incubate & centrifuge QFG tubes

Forward all samples to SCL Dunedin

Phlebotomy:
Enter in CMS & charge. Test = Otago UNIVERSITY
Student Health Screen. Transport in red bag
Lab:
Test Code: SEN1
Requesting Dr / Location: ZNR
Incubate QFG
Give form & SST to IMM
IMM: centrifuge all tubes & forward to Sendaways
Number & scan to Dunedin
Despatch all samples to Dunedin

SAMPLES REQUIRED:
2 x SST yellow top
1 x set of Quantiferon tubes

LAB INSTRUCTIONS
Do NOT add
to Ultra
Incubate & centrifuge
QFG tubes
Forward request form & all
tubes to SCL Dunedin

LAB INSTRUCTIONS
Collection Centre Instructions

If collection Centre does not do Quantiferon, refer patient to appropriate collection centre (Mon Fri 7am-1pm)
Payment is required
No additional collection fee to be added
Centrifuge 2x SST gold tubes
Send all specimens and form in purple commercial bag

Specimen Reception Instructions

Timestamp samples
Photocopy form and scan to HUDE
Give original form, 2x SST gold tubes & Quantiferon samples to Refers
Refers Instructions
2x SST tubes & original form to be held at 2-8C until Quantiferon tubes are ready
Place Quantiferon tubes in rack labelled Dunedin, at 8.00pm put rack in Biochem drop-off.
Once Quant tubes are incubated & centrifuged, send all tubes (2x SST & Quant) with matched request form to SCL Dunedin
Authorised by R.Barton, SCL Dunedin, 11 October 2016
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University of Otago

Laboratory Collection Centres (with EFTPOS payment facilities)

Auckland
Ascot Hospital Greenlane
Weekdays 7.30am 5.00pm
Mercy Ascot Hospital, 90 Greenlane Road East,
Greenlane
Botany Road

Weekdays: 7.00am 5.45pm

Botany Superclinic, 260 Botany Road, Botany

City Quay West

Weekdays: 8.00am 5.30pm

Quay West, Cnr Albert Street and Mills Lane

City Queen Street

Weekdays: 7.00am 5.30pm

Level 2, 280 Queen Street, Auckland CBD 1010

Glenn Innes

Weekdays: 7.00am 3.45pm

161 Line Road, Glen Innes 1072

Henderson

Weekdays: 7.00am 5.45pm

51 lincoln Road, Henderson 0610

Mairangi Bay
Weekdays: 7.00am 5.45pm

Apollo Health & Wellness Centre, 119 Apollo Drive,

Mairangi Bay 0630

Manurewa

Weekdays: 7.00am 5.45pm

161 Great South Road, Manurewa

Mercy Hospital Epsom

Weekdays: 8.00am 5.00pm

Mercy Hospital, 98 Mountain Road, Epsom 1023

Milford

Weekdays: 7.00am 4.45pm

2B Dodson Avenue, Milford 0620

Mt Eden

Weekdays: 7.00am 5.45pm

655 Dominion Road, Mt Eden, 1041

Mt Wellington

Weekdays: 7.00am 4.45pm

37-41 Carbine Road, Mt Wellington 1060

Northcote

Weekdays: 7.00am 4.45pm

16-18 College Road, Northcote, 0627

Orewa

Weekdays: 7.00am 4.45pm

18 Tamariki Avenue, Orewa 0931

Otara
Weekdays: 7.00am 3.45pm

Shop 6, Otara Town Centre, 120 East Tamaki Road,

Otara 2023

Point Chevalier

Weekdays: 7.00am 5.00pm

1194 1196 Great North Road, Pt Chevalier 1022

Ponsonby

Weekdays: 7.00am 5.00pm

White Cross Medical Centre, 202 Ponsonby Rd, 1011

Pukekohe

Weekdays: 7.00am 5.00pm

Level 1, 122 Remuera Road, Remuera

St Heliers
Weekdays: 7.00am 4.45pm

Eastmed Medical Centre 188 St Heliers Bay Road,

St Heliers 1071

Waiheke Island

Weekdays: 7.00am 2.00pm

143 Ocean View Road, Oneroa, Waiheke Island 1081

Weekdays: 8.30am 5.00pm

120 Burnett Street, Ashburton 7700

Canterbury
Ashburton

Barrington
Weekdays: 7.30am 4.30pm

Barrington Medical Centre, 14-18 Athelsten Street,

Spreydon 8024

Papanui
Weekdays: 7.00am 4.00pm

St Georges Hospital, Canon Wilford Wing, Heaton Street,

Papanui 8014

Papanui
Weekdays: 7.00am- 5.00pm

St Georges Hospital, Milford Chambers, 249 Papanui

Road, Papanui 8014

Rangiora

Weekdays: 7.30am 4.30pm

237C High Street, Rangiora 7400

Selwyn Street

Weekdays: 7.30am 4.30pm

316a Selwyn Street, Spreydon 8024

Peterborough Street

Weekdays: 7.30am 5.00pm

Saturday: 8.00am 11.00am

132 Peterborough Street, Christchurch Central 8013

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Hamilton
Hamilton East

Weekdays: 8.00am 4.30pm

Medlab, 248 Grey Street, Hamilton East, 3216

Hastings

Weekdays: 7.30am 4.00pm

Saturday: 9.00am 11.00am

114 Maraekakaho Road, Hastings, 4120

Havelock North

Weekdays: 7.30am 6.00pm

Saturday: 9.00am 11.00am

Community Health Centre, 33-35 Napier Road,

Havelock North

Napier

Weekdays: 7.30am 6.00pm

Saturday: 9.00am 11.00am

115 Vaultier Street, Napier 4110

Nelson

Weekdays: 7.30am 4.30pm

65 Collingwood Street, Nelson 7010

Motueka

Weekdays: 7.30am 2.00pm

158 High Street, Motueka 7120

Dunedin

Weekdays: 7.30am 4.30pm

Saturday: 9.00am 11.30am

95 Hanover Street, Dunedin Central 9016

Oamaru

Weekdays: 7.30am 5.30pm

8 Steward Street, Oamaru 9400

Balclutha

Weekdays: 8.30am 4.30pm

Clutha Health First, 3-7 Charlotte Street, Balclutha 9230

Gore

Weekdays: 8.30am 1.00pm and

1.30pm 5.00pm

Gore Hospital, 9 Birch Lane, Gore 9710

Queenstown - Frankton

Weekdays: 8.00am 5.30pm

Saturday: By appointment

3 Gray Street, Franktown Village 9300

Queenstown

Weekdays: 8.00am 12.30pm and

1.00pm 4.30pm

Queenstown Medical Centre, 9 Isle Street,

Queenstown 9300

Clyde
Invercargill

Weekdays: 8.30am 5.30pm

Weekdays: 7.00am 5.30pm

Dunstan Hospital, Hospital Street, Clyde 9391

78 Don Street, Invercargill 9810

Weekdays: 8.00am 5.00pm

114a Tuwharetoa Street, Taupo 3330

Timaru

Weekdays: 7.30am 5.30pm

Timaru Hospital, Level 2, Queen Street, Timaru 7910

Dee Street

Weekdays: 7.30am 4.30pm

4 Dee Street, Timaru 7910

Blenheim

Weekdays: 8.00am 5.00pm

Wairau Hospital, 30 Hospital Road, Witherlea 7201

Blenheim

Weekdays: 7.30am 12.30pm

9 Maxwell Road, Blenheim

Courtenay Place

Weekdays: 7.00am 5.30pm

Saturday: 8.30am 12 noon

89 Courtenay Place, Wellington

Lambton Quay

Weekdays: 7.30am 4.30pm

256 Lambton Quay, Wellington

Newtown

Weekdays: 8.00am 4.30pm

74 Riddiford Street, Newtown

Lower Hutt

Weekdays: 7.00am 5.30pm

Saturday: 8.30am 12 noon

Cnr of Raroa Road and Cornwall Streets, 17 Raroa Road,

Lower Hutt

Porirua

Weekdays: 7.30am 4.30pm

Saturday: 9.00am 12 noon

6 Hartham Place, Porirua

Hawkes Bay

Nelson

Otago/Southland

Taupo
Taupo

Timaru

Wairau

Wellington

Johnsonville
Weekdays: 8.00am 5.00pm
1st Floor, 24 Moorefield Road, (Above Johnsonville
Medical Centre)
Upper Hutt

Weekdays: 8.00am 4.15pm

Saturday: 8.30am 12 noon

Level 6, CBD Towers, 84-90 Main Street, Upper Hutt

Kilbirnie

Weekdays: 7.30am 4.30pm

68 Bay Road, Kilbirnie

Paraparaumu

Weekdays: 7.30am 4.45pm

129a Rimu Road, Paraparaumu

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