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Please complete a <a rel="noopener noreferrer" href="https://wellbeing.uw.edu/wp-content/uploads/2025/01/SON_Annual-TB-Risk-Assessment-Form_01.08.2025.pdf" class="Hyperlink SCXW251028119 BCX0" target="_blank">HSIP Annual TB Risk Assessment</a> submit the form for approval.&nbsp;
</div>
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Note:&nbsp;
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<div class="ListContainerWrapper SCXW251028119 BCX0">
<ul role="list" class="BulletListStyle1 SCXW251028119 BCX0">
<li data-aria-level="1" data-aria-posinset="3" aria-setsize="-1" data-list-defn-props="{&quot;335552541&quot;:1,&quot;335559685&quot;:770,&quot;335559991&quot;:360,&quot;469769226&quot;:&quot;Symbol&quot;,&quot;469769242&quot;:[8226],&quot;469777803&quot;:&quot;left&quot;,&quot;469777804&quot;:&quot;&quot;,&quot;469777815&quot;:&quot;hybridMultilevel&quot;}" data-listid="8" data-font="Symbol" data-leveltext="" role="listitem" class="OutlineElement Ltr SCXW251028119 BCX0">
Full student name, student number, signature, and date of signature are required.&nbsp;
</li>
</ul>
</div>
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<ul role="list" class="BulletListStyle1 SCXW251028119 BCX0">
<li data-aria-level="1" data-aria-posinset="4" aria-setsize="-1" data-list-defn-props="{&quot;335552541&quot;:1,&quot;335559685&quot;:770,&quot;335559991&quot;:360,&quot;469769226&quot;:&quot;Symbol&quot;,&quot;469769242&quot;:[8226],&quot;469777803&quot;:&quot;left&quot;,&quot;469777804&quot;:&quot;&quot;,&quot;469777815&quot;:&quot;hybridMultilevel&quot;}" data-listid="8" data-font="Symbol" data-leveltext="" role="listitem" class="OutlineElement Ltr SCXW251028119 BCX0">
All three questions must be answered.&nbsp;
</li>
</ul>
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<ul role="list" class="BulletListStyle1 SCXW251028119 BCX0">
<li data-aria-level="1" data-aria-posinset="5" aria-setsize="-1" data-list-defn-props="{&quot;335552541&quot;:1,&quot;335559685&quot;:770,&quot;335559991&quot;:360,&quot;469769226&quot;:&quot;Symbol&quot;,&quot;469769242&quot;:[8226],&quot;469777803&quot;:&quot;left&quot;,&quot;469777804&quot;:&quot;&quot;,&quot;469777815&quot;:&quot;hybridMultilevel&quot;}" data-listid="8" data-font="Symbol" data-leveltext="" role="listitem" class="OutlineElement Ltr SCXW251028119 BCX0">
If you indicate "Yes" to one of the questions on the HSIP Annual TB Risk Assessment form, a subsequent tag will be created for you to complete the HSIP Tuberculosis Symptoms Screening (TBSS) form. &nbsp;
</li>
</ul>
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&nbsp;If you have questions, please contact HSIP at <a rel="noopener noreferrer" href="mailto:myshots@uw.edu" class="Hyperlink SCXW251028119 BCX0" target="_blank">myshots@uw.edu</a>.&nbsp;
</div>

Please complete a submit the form for approval. 

Note: 

 * Full student name, student number, signature, and date of signature are required. 

 * All three questions must be answered. 

 * If you indicate "Yes" to one of the questions on the HSIP Annual TB Risk Assessment form, a subsequent tag will be created for you to complete the HSIP Tuberculosis Symptoms Screening (TBSS) form.  

 If you have questions, please contact HSIP at . 

UW HSIP- Subsequent TB Risk Assessment 

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"Referred to Institution" What Does This Tag Mean?

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 UW – Illegible

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UW - Document Error

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AU- Chest x-ray not accepted

AU- Positive TB test

Missing UH TB Screening

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Insurance Form (Part B) Missing

UW - Needs 2 MMR (MMR Under 1)

UW - Needs 1 Measles (MMR Under 1) 

UW - Needs 1 Mumps (MMR Under 1)

Tarleton Conscience Exemption

TB Confirmation By US Practitioner

Medical Exemption Request

Religious Exemption Request

Need TDAP vaccine from age 10 or older

Missing TDAP from age 10 or after

Missing Meningitis Vaccine Date

DEXT3

DEXT1

TB Outside of the US Not Accepted

NEIU- TDAP Expired

Not Required, Age Exempt- 22 Or Older

Missing Date Polio #1

Missing Date Polio #2

Missing Date Polio #3

Missing date Polio #4

Missing ULV TB Screening Form

Missing ULV Health History Form

Contact ULV Health Center

Missing QuantiFERON Gold in the US 

UW HSIP - Required Hepatitis B

UW HSIP - Required TB Risk Assessment 

UW HSIP - Required MMR

UW HSIP - Required Varicella  

UW HSIP - Required Tdap  

UW HSIP - Required Tuberculosis Screen

UW HSIP - Required Influenza Vaccine  

UW HSIP - Required COVID-19 Vaccine

UW HSIP- Rejected Document Type  

UW HSIP- Rejected Unverifiable Document 

UW HSIP- Rejected No Name on Record

UW HSIP- Rejected Portal Submission 

UW HSIP- Rejected Result Trends 

UW HSIP- Rejected MMR Negative Titer(s) 

UW HSIP- Rejected MMR Invalid Age Dose 

UW HSIP- Rejected Varicella Neg Titer 

UW HSIP- Rejected HepB Dose #3 Invalid 

UW HSIP- Rejected HepB Dose #2 Invalid

UW HSIP- Rejected HepB Titer Submitted 

UW HSIP- Rejected HepB Titer Incorrect 

UW HSIP- Rejected HepB Qualitative Titer 

UW HSIP-Rejected TB Risk Assessment Form

UW HSIP- Rejected TB Screening Outdated 

UW HSIP- Rejected PPD Skin Test Single 

UW HSIP- Rejected PPD Skin Test Record 

UW HSIP- Rejected TB Screening Positive 

UW HSIP- Rejected Td Submitted W/O Tdap 

UW HSIP- Rejected Tdap Vaccine Outdated 

UW HSIP- Rejected Flu Vaccine Outdated 

UW HSIP- Rejected CV-19 Vaccine Outdated 

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