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Health Record

The Health Record must be completed and submitted to Butler College Health Services before the first day of class according to the course syllabus. The Health Record must be completed no earlier than 3 months before the first day of class for the semester. Only the Butler Health Record form may be used, and must be signed by a MD, DO, ARNP, or Physician Assistant.

Health Forms for First Time Students Entering the nursing program: First Semester, LPN or Transfer Students

Health record form for Butler Department of Nursing.
Immunization Form – Includes Vaccine record and CPR record.

Updated Health Forms for Students continuing into the second year of the program

Health record form for Butler Department of Nursing
Immunization Form – Level II

Return to Clinical Requirements
Updated September 2011