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 http://wellness.uchicag.edu/page/vaccinatins-requiredenrllment 4. If yu are unable t get the vaccinatins befre arriving, yu will need t make an appintment with SHS. Please call SHS at 773-702-4156 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 773-702-4156 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 email sccimm@uchspitals.edu r call 773-702-4156 and let us knw what vaccines yu are unable t get and we will make an appintment fr yu.
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 http://wellness.uchicag.edu/page/vaccinatins-required-enrllment. *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 (http://registrar.uchicag.edu/ ) Rute questins t sccimm@uchspitals.edu r call (773) 702-4156.
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: E-mail: 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.
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
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 http://wellness.uchicag.edu/page/vaccinatins-required-enrllment 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 email t cmplianceservices@medicat.cm Cmpliance Services will respnd t all student inquires via email 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.
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 123456.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 email. Checking yur Status Once lgged int the Cmpliance Services Management System, select View Histry and yu can view yur status. 2 P age