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Positive
PPD Questionnaire
Residents
who CANNOT undergo an annual PPD test due to a previous positive,
BCG vaccine, etc., must complete the Positive PPD Questionnaire annually.
Click here for a copy to
print, complete and return to KJL HealthCare Management Inc. by postal
mail, fax, or scan and email (info below).
Temporary
Waiver of Annual PPD Requirement
Residents
who cannot undergo an annual PPD test at this time (ex: pregnancy),
but will at a later date, click here
for a copy of the Temporary Waiver form to print, complete and return
to KJL HealthCare Management, inc. by postal mail, fax, or scan and
email (info below).
PPD
Test Result Documentation
Click here for a copy of the PPD Test
Result Documentation form to print and take to the provider who will
place and read your PPD test. You are responsible to return this form,
or a copy of the form used by the provider who places your PPD, to
KJL HealthCare Management as indicated below.
Return
the above forms and/or your PPD result documentation to:
KJL
HealthCare Management, Inc.; 10746 East Dorado Avenue; Englewood,
CO 80111.
Fax: 303-290-6794. Scan and email: klee80111@gmail.com
Immunization Screening
Forms
Immunization
Screening & TB Respirator Mask Fits are mandatory for all residents
new to UC Denver Graduate Medical Education programs and must be completed
within one week of the resident's training start date.
To
schedule appointments contact:
KJL HealthCare Management
klee80111@gmail.com
Before the scheduled appointment, the resident is to complete and forward the Infectious Disease & Immunization Summary & Screening-Related Forms.
These forms are in the new resident packet distributed in March each year or by clicking on the above link.
Residents should completely fill out the 5 page form, place it in the 6x9 envelope provided in the packet, print his/her name and program legibly on the outside of this envelope and return it, along with the rest of the packet, to the Program Coordinator. Coordinator will forward to GME with other packet paperwork.
Residents who do not complete these requirements endanger themselves, their families, colleagues and patients; are in violation of their training agreement and are non-compliant with state, federal and affiliated hospital regulations. Please be certain each new resident in your program completes the immunization screening and TB Respirator Mask Fit Testing.