Instructions for Completing Required Health and Immunization Requirements
- Download the student information packet here. The packet includes a student checklist along with copies of the forms you will need to submit to the Health Service.
- Forms included in the packet that must be submitted by June 28, 2013 are:
- Immunization Form for Entering Graduate Students- All students must submit a clinically documented immunization record.
- Tuberculosis (TB) Screening Form- All students must sign and submit the screening form for tuberculosis.
- Tuberculosis Testing Form- Any student who answers 'yes' to one or more questions (#2 through #9) on the Tuberculosis Screening Form must submit a health care provider Tuberculosis Testing Form.
- Complete the required Online Health Forms accessed through your Banner page. NOTE: This requires Banner access. You will receive access information from the office of your program of study prior to the start of classes. Complete the online portion of your requirements once you have received Banner access. Don't let lack of Banner access stop you from completing the paper forms referenced in Step 1. Once you have Banner access follow these steps to complete the online forms:
- Go to: http://www.dartmouth.edu/bannerstudent and enter your username and password
- At the main Banner menu page click on the Health Services link, ‘Health Center Online'. (You may need to temporarily allow pop-up blockers. Or, to bypass the pop-up blocker, hold down the ‘Ctrl' key while you click on the link. If you receive a Security Certificate Notification, please click to continue through to the web page. This notification may appear on computers with newer security protocols, so not all will receive this message.)
- Select the ‘Forms' tab from the 'Health Center Online' menu. (Some Mac computers will not allow access to this page. If you are using a Mac and after following the above instructions are unable to access the page, you may need to try from a different computer.)
- Complete the following online forms:
- Authorization to Provide Medical Treatment- Your consent allows you to be seen at the Health Service (Dick's House).
- Health History Form- Enter your medical history and family history details here.
- Dartmouth Hitchcock Agreement for Electronic Access- Your consent gives your health care provider at the Health Service access to your DHMC record for continuity of care.
- Immunizations- Use your copy of the paper immunization form to enter dates of your vaccines. Your paper immunization form will not be processed at the Health Service until you have successfully completed the online immunization form.
- New Hampshire Patient Bill of Rights- You are acknowledging you have reviewed the NH Patient Bill of Rights.
- Notice of Privacy Practices- You are acknowledging you have reviewed the Privacy Practices.
- Submit the following completed paper form(s) to: Dartmouth College Health Service, ATTN: Medical Records, 7 Rope Ferry Road, Hanover, NH 03755. Mail delivery is preferable but you may also email or fax forms to the Health Service.
- ALL STUDENTS: Immunization Form (completed by a health care provider)- Did you keep a copy of your immunization record to assist you in completing the online immunization form?
- ALL STUDENTS: Tuberculosis Screening Form (completed by student)-Did you answer all questions and sign at the bottom of the form?
- IF APPLICABLE TO YOU: Tuberculosis Testing Form (completed by a health care provider)
Common Questions and Answers
Q: Do I need to have a physical exam prior to coming to Dartmouth?
A: No, the Health Service does not require a physical exam. We ask that you provide us with your medical history, allergies, medications, family history, etc. when completing the online Health History form.
Q: What happens if I don't complete the requirements prior to the deadline?
A: If you are not in compliance with health and immunization requirements prior to the deadline you risk having a health hold placed on your Banner account. A health hold can prevent you from electronically checking in for your first term.
Q: Do I have to complete these requirements if I waived out of the Dartmouth Student Group Health Plan?
A: Yes! The health and immunization requirements are separate from the insurance portion of your requirements.
Q: I have most of my information ready to go but am missing proof of one of the required immunizations. Should I send in the information that I currently have or wait until everything is complete?
A: Please send us the information you currently have and follow-up with clinical documentation of any remaining vaccines.
Q: Do I have to complete the 'Tuberculosis Testing Form' even if I answered 'no' to all questions on the 'Tuberculosis Screening Form'?
A: No. If you have candidly answered 'no' to all of the screening questions you do not have to submit a 'Tuberculosis Testing Form'.
Q: Do I have to complete both the online immunization form AND submit the paper immunization record?
A: YES! We require a hard copy of the immunization record to authenticate the information entered into the online form.
Q: Do I have to mail a copy of the immunization and tuberculosis forms if I have already emailed or faxed them?
A: Mail is the preferable delivery method for your health forms. However, if you have already emailed or faxed your forms to us please do not submit a duplicate copy. We do not require "originals". Legible copies are accepted.
If you have any questions about the immunization and health requirements please contact Annie Greenwood in the Medical Records Office at 603/646-9404 or e-mail Medical.Records@dartmouth.edu.