Dear University of Chicago Student,

Transcription

1 Dear University f Chicag Student, The state f Illinis and the University f Chicag require students t have prf f immunity fr certain diseases including Measles (Rubela), Mumps, Rubella (German Measles) Tetanus/ Diphtheria/Pertussis Meningcccal fr thse under 22 years f age The deadline fr submitting prf f immunizatins is 1 week befre the 1 st day f the 1 st quarter. The Student Health Service (SHS) is available t help yu btain the vaccinatins that yu need. Please fllw the steps belw t start the prcess f becming cmpliant with vaccinatin requirements: 1. Cmplete the Immunizatin Frm belw r btain a cpy f yur vaccinatin recrd frm yur healthcare prvider: a physician licensed t practice (M.D. r D.O.), a Licensed Nurse, r a Public Health Official. Please make sure that the recrd is in English; translatins f nn-english dcuments must be certified. 2. Determine what vaccinatins yu will need and make every effrt t btain them prir t arrival n campus. If yu have questins abut what yu need, please ask yur healthcare prvider abut the vaccinatins mentined abve. 3. Submit a cpy f yur recrds t ur Cmpliance Management System lcated n ur website at 4. If yu are unable t get the vaccinatins befre arriving, yu will need t make an appintment with SHS. Please call SHS at and indicate that yu need t make an appintment t get yur vaccinatins. Please bring a cpy f yur recrds fr us t review. Frequently asked questins: What is the cst f the vaccines? The required vaccines, like MMR, Tetanus and Meningcccal are free f charge t yu if yu have paid the Student Life Fee (included in yur tuitin bill). What if I have sme but nt all the vaccines needed? We will review yur recrds and give yu the vaccines yu need. Yu will have t make an appintment t get the vaccines as sn as yu arrive n campus. Please call SHS at What if I dn t get the vaccines? Yu will be blcked frm registering fr classes in subsequent quarters. What if I cannt get the vaccines where I live? Just sccimm@uchspitals.edu r call and let us knw what vaccines yu are unable t get and we will make an appintment fr yu.

2 Student Immunizatin Requirements Students must uplad immunizatin frms int the Cmpliance Management System n later than ne week prir t the beginning f their first quarter at the University f Chicag. The link can be fund at *Failure t return yur immunizatin frm r cmplete the required vaccinatins will result in a restrictin n yur student accunt, which will deny yu the ability t enrll in future classes. New students are required t prvide dcumentatin f the fllwing vaccines: MEASLES, MUMPS, RUBELLA (MMR): Vaccines fr MMR must be given n r after 12 mnths f age (n r after the student s first birthday). Tw (2) Measles (Rubela) vaccines, separated by at least 28 days, are required. Fr measles vaccines given befre 1968, prf must be submitted that a live-virus vaccine was administered. Histry f disease is nt acceptable as prf f immunity fr Rubella. Titers are required fr prf f immunity in thse wh have a histry f disease. Students brn n r befre January 1, 1957 will nt have t prvide immunity fr MMR TETANUS/DIPTHERIA/PERTUSSIS (DPT, DTP, DT, DTaP, Td r Tdap) All students must shw prf f vaccinatin f three (3) dse dates fr Tetanus/Diphtheria/Pertussis immunizatin One dse must be a Tdap (tetanus, diphtheria and acellular pertussis) vaccine One dse must have been given within 10 years f first date f Quarter. MENINGOCOCCAL (Menactra MCV4, Menmune MPSV4, Menve ): Required fr all new students under the age f 22 One de must have been given n r after 16 th birthday. Imprtant infrmatin: A licensed healthcare prvider must cmplete the immunizatin frm. A health care prvider is: a physician licensed t practice (M.D. r D.O.), a Licensed Nurse, r a Public Health Official. ENGLISH: All immunizatin frms and cpies f labratry reprts must be submitted in English. Translatins f nn-english dcuments must be certified. It is acceptable t have an English translatin f the dcuments certified as accurate by a member f the University cmmunity wh is fluent in the dcument s riginal language. EXEMPTIONS: The fllwing exemptins may be allwed. Anyne with a vaccine exemptin may be excluded frm the University/Cllege in the event f a Measles, Mumps, Rubella r Diphtheria utbreak in accrdance with public health law. MEDICAL CONTRAINDICATIONS: a written, signed, and dated statement frm a physician stating the vaccine that is cntraindicated, the nature, and duratin f the medical cnditin that cntraindicates the vaccine(s). This statement will nt be accepted if it des nt meet the standards f care at The University f Chicag Hspitals. Submit this statement t the SHCS sccimm@uchspitals.edu Student Health Service Immunizatin Prgram. PREGNANCY OR SUSPECTED PREGNANCY: a signed statement frm a physician stating the student is pregnant r pregnancy is suspected. Pregnancy exemptins are applicable nly t Measles, Mumps, and Rubella requirements. Submit this statement t sccimm@uchspitals.edu the SHCS Student Health Service Immunizatin Prgram. AGE EXEMPTION: Persns brn befre January 1, 1957 are cnsidered immune t Measles, Mumps, and Rubella. Requirements may be met by the submissin f a cpy f the student's birth certificate, driver's license, r passprt identifying the birth date. RELIGIOUS EXEMPTION: a written, signed, and dated statement by the student detailing the student s bjectin t immunizatin n religius grunds. Request fr religius exemptins will be frwarded fr review and nly be granted by the Registrar. Submit this statement t the University Registrar ( ) Rute questins t sccimm@uchspitals.edu r call (773)

3 Student Immunizatin Recrd Part I Student Infrmatin Student ID#: First Quarter Attending: Fall / Winter / Spring / Summer Last Name: First Name: _ MI: Date f Birth: Sex: Phne Number: Parts II - IV are t be cmpleted by a Healthcare prvider. All dates must include MONTH,DAY and YEAR. Part II Measles, Mumps, Rubella Students brn n r befre January 1, 1957 will nt have t prvide immunity fr MMR MMR #1 Date f Vaccine _ / / (must be given n r after 12 mnths f age/first birthday) MMR #2 Date f Vaccine _ / / (must be given at least 28 days after MMR #1) - OR - If individual vaccines were received fr Measles, Mumps, and Rubella, please cmplete the fllwing: Measles (Rubela) Vaccine Date f Vaccine # 1 / / Date f Vaccine # 2 / / Rubella (German measles) Vaccine Date f Vaccine # 1 / / Date f Vaccine # 2 / / Mumps Vaccine Date f Vaccine # 1 / / Date f Vaccine # 2 / / If prf f vaccine cannt be prvided, a student must btain a bld titer t cnfirm immunity f any f the abve. A cpy f the labratry test in English must be submitted.

4 Student ID#: _ First Quarter Attending: Fall / Winter / Spring / Summer Part III Tetanus/Diphtheria/Pertussis (DPT,DTP,DT,DTap,Td r Tdap) All students must shw prf f vaccinatin f three (3) dse dates fr Tetanus/Diphtheria/Pertussis immunizatin One dse must be a Tdap (tetanus, diphtheria and acellular pertussis) vaccine One dse must have been given within 10 years f first date f Quarter Tetanus Txid vaccine is nt acceptable in fulfilling this requirement Date f Vaccine # 1 / / DPT, DTP, DT, DTap, Td r Tdap Date f Vaccine # 2 / / DPT, DTP, DT, DTap, Td r Tdap Date f Vaccine # 3 / / DPT, DTP, DT, DTap, Td r Tdap Part IV Meningcccal Vaccine (Menactra MCV4, Menmune MPSV4, Menve r Meningcccal) Required fr all new students under the age f 22 One dse must have been given n r after 16 th birthday Date f Vaccine / / Prvider(s) Signature: Prvider(s) Printed Name: Address: Phne Number: Healthcare Prvider Certificatin

5 Medicat Cmpliance Services COMPLIANCE SERVICES QUICK REFERENCE SHEET FOR STUDENTS Cmpliance Services allws students t enter their wn health infrmatin int a secure nline student prtal. This infrmatin is verified and apprved by a health administratr wh can track cmpliance r lack f cmpliance and reprt back t the student thrugh secure messaging. Cmpliance Services makes it easy t check that student requirements are satisfied and generate reprts which track and mnitr student immunizatin activity. This sheet is a quick guide t sme cmmn issues that arise fr students using Cmpliance Services. Requirements Each student is respnsible fr understanding the requirements f their institutin. Each student is respnsible fr meeting the submissin deadlines set by their institutin and understanding that the cnsequences f nt satisfying the requirements culd include terminatin. All supprting dcumentatin must include a student s full name (first and last) and their birthdate fr verificatin purpses. Accessing the Cmpliance Services Management System Using any brwser n a cmputer r mbile device, g t Students will use their University Credentials (Cnet ID) t access the nline systems fr Cmpliance Services. Any questins yu have regarding these credentials r frgtten passwrd, please visit cnet@uchicag.edu. Access Prblems If there is any difficulty accessing Cmpliance Services r uplading dcuments, please send an t cmplianceservices@medicat.cm Cmpliance Services will respnd t all student inquires via within ne business day. Entering Immunizatin Recrds n the Cmpliance Services Management System Each student is respnsible accessing the Cmpliance Services Management System t accurately enter their immunizatin histry nt their Immunizatin Recrd. Students must enter individual dates fr each vaccinatin required by their institutin. It is highly recmmended that students enter all nn-required vaccinatins nt their recrd, such as HPV vaccines, Flu vaccines, r ther immunizatins nt required by their institutin. Uplading Immunizatin Dcuments Dcuments that are upladed directly must be in ne f the fllwing frmats:.gif., png., tiff., tif., jpg., jpeg., txt., r.pdf.

6 Micrsft Wrd files such as.dc,.dcx r.dcm frmats are nt accepted. Please make sure that yur file name cnsists f nly alpha and numeric characters in the file name. NO SPECIAL CHARACTERS OR EXTRA SPACES ARE ALLOWED. Examples f ACCEPTABLE file names: JaneSmithRecrds.jpg bmp Examples f UNACCEPTABLE file names: Jane Smith Recrds. Jpg (Unacceptable due t spaces between wrds) ImRecrd#1.bmp (Unacceptable due t special character # ) What t Expect After Submissin Upladed dcuments are available immediately fr review by MCS Staff. It typically takes 5 business days t prcess immunizatin recrds. Once recrds have been successfully reviewed and matched, students will be ntified by . Checking yur Status Once lgged int the Cmpliance Services Management System, select View Histry and yu can view yur status. 2 P age