Employee Health & Safety

Welcome to Physicians Immediate/Urgent Care,

In order to promote and maintain a safe and healthy environment for our employees, patients
and visitors, the following vaccinations or proof of immunity, are required prior to beginning

  • Hepatitis B Vaccines x 3, Titer showing immunity, or Declination statement
  • QuantiFERON titer
  • MMR Vaccines x 2 or Titer showing immunity to: Rubeola, Mumps, and Rubella
  • Varicella Vaccines x 2 or Titer showing immunity
  • Latex Allergy Questionnaire (provided below)
  • Influenza Vaccine if hired September – March.
  • Tdap Booster, recommended every 10 years
  • COVID-19 Vaccine, strongly recommended
    (2-doses for Moderna & Pfizer, 1-dose for Johnson & Johnson)

To save time and a needle stick, please send Employee Health a copy of your immunization
. Additionally, complete the Latex Allergy Questionnaire below, click the submit button
at the end of the form.

If records cannot be obtained, PIC will provide you with either titers or vaccinations
depending on employee needs.

If you have any questions, please contact Employee Health at eh@visitphysicians.com. We look
forward to working with you.

Employee Health Team

MM slash DD slash YYYY
1. Have you ever had an anaphylactic reaction to latex devices/products?
2. Have you ever been told by a doctor that you have an allergy to any latex product?
3. Have you had a reaction to the following personal sources of latex?
a. Balloons
i. Latex birth control devices
b. Rubber gloves
j. Erasers
c. Hot water bottles
k. Face Masks
d. Rubber bands, balls
l. Elastic bandages
e. Foam pillows
m. Cuffs, elastic waist bands
f. Baby bottles, nipples
n. Ostomy bags
g. Pacifiers, teething rings
o. Shoes or other footwear
h. Belts, bras, suspenders
After handling latex products, have you experienced any of the following:
a. Difficulty breathing:
e. Redness:
b. Runny nose/congestion:
f. Cracking or chapping hands:
c. Itching hands or eyes:
g. Swelling:
d. Hives:
Do you have allergies to any of the following:
a. Bananas:
f. Kiwis:
b. Avocados:
g. Chestnuts:
c. Potatoes:
h. Peaches:
d. Tomatoes:
i. Papaya:
e. Poinsettia:
This field is for validation purposes and should be left unchanged.