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Welcome Class of 2018!     ** Health requirements are due by June 30, 2014! **

Instructions for Completing Required Health and Immunization Requirements:

ALL STUDENTS: Download the 'Undergraduate Checklist', here. Following the checklist will ensure you meet all requirements.

PRINTABLE FORMS:

  1. Immunization Form
  2. Tuberculosis (TB) Screening and Testing Form
  3. Athletic History & Physical Form (for NCAA & Rugby Participants ONLY!)
    • The NCAA form is due by the June 30th deadline. If you have a physical exam scheduled with your home doctor in August or September it is okay for you to submit the NCAA form after the appointment.
  4. Special Authorization for Minors (for students who will be under age 18 on September 1, 2014, ONLY!)

ONLINE FORMS TO COMPLETE:

Complete the series of online health forms accessed through your Banner page following the steps below:

    • Go to: http://www.dartmouth.edu/bannerstudent/ and enter your NetID and password (created in the "claim your account" process).
    • Look for the 'Health Services Forms' link under 'Information Required Prior to Check-In'.
    • Select the ‘Forms' tab from the 'Health Center Online' menu.
    • Complete the following ONLINE forms:
      • Authorization to Provide Medical Treatment- Your consent allows you to be seen and treated 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.
    • Do not complete the NCAA online form. This form applies to returning athletes only.

MAIL, FAX OR EMAIL PAPER HEALTH FORMS 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. Please choose one delivery method. We do not require "originals".

 

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'  if I answered 'no' to all questions on the 'Tuberculosis Screening Form'?

A: No. If you have candidly answered 'no' to all of the tuberculosis screening questions you do not have to complete the 'Tuberculosis Testing Form'. However, you must still submit a copy of the Tuberculosis Screening Form to us.

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 of forms 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.

Last Updated: 6/12/14