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University Health Service

Health History Form FAQs

Q#1: I started filling out my form in ink. Is that ok? While we prefer you to use a pencil for the entire form, it is ok to use blue or black ink. If you have not finished the form, please switch to pencil to finish the rest of the form. You do not need to request a new form.

Q#2: What immunizations are required? Students must meet the New York State and University of Rochester immunization requirements. For the full list of mandatory immunizations, check Immunization Requirements for Full-time Students.

The mandatory immunizations are as follows:

  • 2 doses of live measles vaccine*
  • 1 dose of mumps vaccine*
  • 1 dose of rubella vaccine*
  • 1 dose of meningococcal vaccine or signed declination
  • PPD (tuberculosis skin test) for students from specific countries. See Q#3 below.
  • 1 TD or Tdap (Tetanus), and
  • 1 Polio (date of completion).

* Note: MMR (measles, mumps & rubella) vaccine may be used to satisfy a single dose of measles, mumps and rubella.

Q#3: Do I have to do a PPD (tuberculin skin test)?  What should I do if I have a positive PPD Test? Students who have lived in a Country that is endemic for Tuberculosis within the last 5 years for a period of more than 3 months at a time (See List of Countries with Low Incidence of Tuberculosis.) or Health Professional Students must take the PPD test. Your test must be within 6 months of the start of your classes. PPD tests completed more than 6 months before admission date are invalid. You do not need a chest x-ray if your PPD result is negative (less than 10 mm). If you have a PPD test that is positive (10mm or over induration) then you must have a chest x-ray done.  Please only provide the chest x-ray report. Do not provide the actual x-ray film or a CD of the results. We must have a printed paper report.

Q#4: I cannot get a PPD test because it is not offered where I am from.  If you cannot get the PPD test (because it is not available in your area) before you come to school, there is another option. It’s called QuantiFERON ®-TB Gold (QFT-G). This is a new FDA approved blood test (titer) for the detection of tuberculosis (TB) infection. QFT-G is highly specific and a positive test result is strongly predictive of true infection of Tuberculosis.   Since this is a blood draw (titer), a copy of the laboratory results must accompany your paperwork. If you do have a Positive test result with a QFT-G test, you must treat it the same as a PPD test and you must have a chest x-ray done. Please only provide the chest x-ray report. Do not provide the actual x-ray film or a CD of the results. We must have a printed paper report.

 Q#5: Does my doctor need to sign my Health History Form? My doctor is no longer in practice. Where can I get my immunization records? We must have official documentation of your immunizations; however, this does not always mean that your doctor must sign the form. If you have official immunization documentation from your school or from your healthcare provider’s office, we can accept that documentation in place of a physician’s signature on your Health History Form. You will still need to fill out the ovals in the immunization section of the University of Rochester’s Health History Form. The official immunization documentation from your past school or healthcare provider serves as the physician’s signature, showing proof of the dates that you entered onto the form.

Q#6: Can I turn in my form late? I cannot schedule an appointment with my doctor until after the due date.  Our goal is to receive the majority of forms from incoming students by June 30 for the fall semester (December 31 for the students beginning in January). If you cannot make the deadline, please send your form as soon as you can. Do not send your immunization records prior to sending the Health History Form. To assure proper input of your information, please send in all of your paperwork including the Health History Form all at the same time.

Q#7: If I cannot get my immunizations completed before I come to school, what should I do? You can receive your immunizations at UHS after you come to campus. Call 585-275-2662 to schedule an appointment. Please let the receptionist know you would like to complete your immunization requirement.  It will be billed to your insurance and you will be responsible if it is not covered.  Our Aetna Student Health Insurances covers most immunizations.

Q#8: Do I need to fill out all the ovals (bubbles) on the Health History Form? Why is there a charge for $25 on the form? Yes, you need to fill in the ovals (bubbles) that match the dates of immunizations on the official immunization record. Please darken the circle completely using a pencil (or blue or black ink pen, if you do not have a pencil). Do not put a check mark or X in the circle. The $25 fee is only for students who do not fully fill in the ovals (bubbles) on the form. Please be sure to sign and date the form where indicated in Part 5. The form cannot be processed without your signature and date.

Q#9: How do I know if you received my Health History Form or if anything is missing? Due to the large number of forms received, we do not send a confirmation to let you know your form has been received. We will notify students whose forms are incomplete or have not been received within 30-45 days after the beginning of classes. If you do not receive a letter from UHS, you can assume your form was received and is complete. Please always check your spam email, just in case. Our suggestion to you is to bring ALL of your immunization records with you when you come to the University of Rochester. Then if your form does not reach us and you need to fill out another one, you can come to Room 203 in the UHS Building and fill out the Health History Form, using your immunization records that you brought with you from home.

Q#10: Can I send a scanned email copy or fax of my form? If you are a full-time student, you must submit the original form. You cannot email or fax your form to our office. Since the form is optically scanned, we can only accept the printed original red bubble form.