Provide information about your health history and immunizations.
Students cannot register for classes until they have fulfilled the immunization and meningitis information requirements listed on this form.
For the best experience use a non-mobile device.
- This form requires the signature or stamp of your health care provider.
- Your health care provider must provide the requested information on this form. Students are not allowed to fill it out themselves.
-This form must be completed in English.
Please use one of the following methods to submit your records:
• Send your forms as soon as possible to facilitate class registration (consider air mail or an express courier)
• Do not return the forms to International Admissions
Once your immunization records have been received, processed, reviewed and deemed compliant with requirements by our immunization coordinator, your IMM and MEN holds will be removed; this will be reflected in your HUB Student Center in real time. This will occur 5-7 business days after we receive your compliant records.
Students will not be individually contacted to confirm receipt of records. Please check the HUB system for the current status of your service indicators.
If your paperwork is not in compliance, you will receive an email from Health Services.
Please contact us only if you have a hold on your account for a prolonged period of time after submitting your records/forms:
Please allow 10 business days for Health Services to process your records and update UBlearns.
Health and immunization records submitted to or generated by Health Services are held on file for 10 years.
In accordance with HIPAA (Health Insurance Portability and Accountability Act), if a patient is 18 years of age or older we cannot release any medical information to a parent, spouse, instructor, employer or anyone else other than the patient him/herself. Patients who would like Health Services to verify an appointment or discuss diagnosis and treatment with anyone other than themselves must sign an authorization consent form during their visit. This consent pertains to that day’s appointment only; a new release form must be signed at each visit.
If other individuals or agencies have provided confidential information to Health Services, you cannot use the authorization form to re-release this information. For copies of medical records that came from another individual or agency, please contact that original individual or agency directly.