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University Requirements for Health Information & Insurance:

Each student is required to have the following documents on file at the Health Center.

  1. Report of Medical History and Physical Exam Form
  2. Immunization Records
    *  Measles, Mumps, Rubella Vaccine
    *  Tetanus Shot
    *  Meningitis Vaccine
    *  Polio
    *  Hepatitis B Vaccine
    *  Varicella (Chicken Pox)
    *  Tuberculosis
  3. Proof of Medical/Hospitalization Insurance
Instructions:

Be sure to follow all instructions carefully.  Incomplete records will be returned and delay registration. 

1.  Report of Medical History and Physical Exam Form
  • Pages 1-3 are to be completed and signed by the student or guardian (if student is a minor)
  • Pages 3-4 are to be completed and signed by your physician
2.  Immunization Records
  • Measles, Mumps, Rubella Vaccine:  Evidence of immunization or titers
  • Tetanus Shots:  Date of shot must be within 10 years of the date of registration.
  • Meningitis Vaccine:  Evidence of immunization or titers
  • Polio:  Evidence of immunization or titers
  • Hepatitis B Vaccine:  Evidence of immunization or titers
  • Varicella (Chicken Pox):  Evidence of immunization or titers
  • Tuberculosis:  PPDA or IGRA within 6 months of registration.  If positive a copy of chest x-ray and any treatment information is required.
3.  Proof of Medical Insurance

Proof of Medical Insurance is required on a yearly basis.  A photocopy of the front and back of your insurance card must be included.  Please note that any medical expenses incurred by the student is solely the student's responsibility.

Forms

Click below for a copy of the Welcome Letter

 

Medical History & Physical Exam From


Medical/Hospitalization Form