Doctor of Nursing Practice – Family Nurse Practitioner

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View instructions for order placement

Health Clearance

In order for the university to comply with Connecticut State Law regarding student immunizations, you are required to have your physician complete the Health Clearance Form. The following form can be downloaded from once you have ordered your Medical Document Manager account.

Health Clearance Form

All nursing students (undergraduate and graduate) are required to create a Medical Document Manager account. Students will not be allowed to participate in any clinical coursework without a compliant Medical Document Manager Account.

Please follow the directions below:

  • Step 1

    Log onto

  • Step 2

    Select Place Order (please note there is a $30 fee).


  • Step 3

    Enter package code RW02im for Medical Document Manager Account (this package code is for our Family Nurse Practitioner students only!)

    Package Code

  • Step 4

    Once account is created, please upload required documents onto your profile. IMPORTANT: After submission of documents, you will need to review your account for compliance. (compliance is indicated with a green checkmark )

  • Step 5

    Once your account is completed and marked compliant, you must submit a copy of the completed Health Clearance Form only (signed by your physician) no later than July 15, 2017 to the Wellness/Health Services Center at Sacred Heart University, 5151 Park Avenue, Fairfield, CT 06825. This is required by Connecticut State Law.

    Health Clearance Form

Your Medical Document Manager must be kept compliant throughout your nursing studies. For example, the following are required annually: health clearance form, influenza vaccine, and TB screening.

Please contact Megan Pollock, Clinical Placement Coordinator at 203-365-4884 or Sandra Miller, Contract Compliance Coordinator at 203-416-3939 with any questions.