New Students: Mandatory Health Clearance 形式

Listed below are the health forms that need to be completed to meet the requirements for registration.

In an effort to facilitate your health clearance at future clinical sites and to fulfill the requirements of the New York State Department of Health Code, these forms 必须 be completed and kept on file in the Employee/学生健康 office.

Your record will be viewed by the 学生健康 personnel, 如果需要的话, referred to the Medical Director for further evaluation prior to clearance.

Please upload all of the below forms to the 学生健康门户网站 using your MyAccounts ID and password.

• 学生健康表格
  This form is to be completed by the student with each item being checked and an explanation for all "yes" answers in the space provided. You may use an additional sheet, if necessary. Your health care provider needs to complete the summary section, sign and date.
• Record of Medical Examination
  Completion of this form requires a physical examination within 6 months prior to beginning classes. All sections of this form are to be completed by your health care provider, with each item marked individually (no lines through will be accepted). 这些表格必须签名, dated and stamped by your health care provider and include address and phone number.
• 免疫接种
  文档 of immunity is 要求. Complete age appropriate vaccination records 必须 提供. If insufficient record, then antibody titers are 要求. Booster vaccine documentation is 要求 if antibody titers are negative or equivocal.

Proof of immunity to the following is 要求:
-麻疹(风疹)
- - - - - -腮腺炎
- - - - - -风疹
- - - - - -水痘
- Proof of 3 Hepatitis B vaccinations and/or positive antibody titer result

COVID-19疫苗 系列 强烈推荐 截至2023年4月11日. Students going to clinical sites outside of 推荐最近最火的赌博软件 may need proof of vaccination to meet that institution's health clearance requirements. 

While antibody titers are not 要求 by 上州医科大学 or NYSDOH if proof of well-documented record of age-appropriate vaccination is available, some external clinical sites within and outside of New York State may require antibody titers to participate in their clinical programs. You may submit evidence of these titers if you have copies of them. Fee for any titers ordered will be the responsibility of the student or billed through their health insurance provider.

• Allergy History Screening Form
  This form is to be completed by the student.
• Meningococcal Vaccine Response Form
  Please read the informational sheet and complete the form.
• Meningococcal Vaccine Letter
• 发布信息 Form for Students
• Tuberculosis Screening Test
  A tuberculosis screening test can be completed prior to arriving on campus, 或者在迎新仪式上表演. Acceptable screening tests are: PPD, QuantiFERON Gold, or T-Spot.  文档 必须 include: date placed, date read (within 48-72 hours of placement), induration in millimeters and signed by the interpreting healthcare provider for PPD and lab report with collection date and result date for QuantiFERON Gold or T-Spot. If you have had a positive tuberculosis screening test please provide documentation of the conversion date and result/induration, chest x-ray (within 12 months), 并服用药物治疗, date started and date completed), 如果适用的话.