New Student Documents

Instructions for Submitting Your Health Forms

Required for New and Transfer Students.

Dear Incoming Drew University New or Transfer Student:

Welcome to Drew University Health Services (“DUHS“)! We hope that your time here will be healthy, happy and always intellectually stimulating.

We are now able to provide resources to conduct your health business electronically.  You are able to complete your health documents before arriving on campus; and where necessary, print out the documents for completion by your health professional prior to mailing them to:

Health Services, Drew University, 36 Madison Ave., Madison, NJ  07940

The following outlines the steps necessary to submit your health information.  Please take the time to read it in its entirety.  Documents must be received by the due date indicated below.  Students will not be permitted to continue registration or reside in Drew housing until immunization and information requirements are met. Any documents that are mailed must be in English.

As a registered student you have confidential and secure online access to forms on your electronic health record through myhealth portal.  Although most information will be completed online in myhealth, there are some documents that need to be printed, completed, and mailed back to DUHS.  All forms must be received by online submission and mail before the following dates:

Online forms to be submitted through myhealth include:

 (These will not be accepted in paper form)

• Authorization for Treatment (if over 18 on arrival day)
• Privacy Practices Acknowledgement (all students)
• Admission Health History (all students)
• Immunization Record(all students)
  • Proof of two Measles vaccines after age one and thirty days apart, or laboratory proof of immunity if born after 1956 (NJ State Law requires that all students born after 1/1/1957 provide documentation of 2 (two) doses of vaccine or laboratory proof of immunity (titer) to measles, mumps and rubella as a condition of attendance at the University.)
    
  • Proof of one Rubella vaccination after age one or laboratory proof of immunity if born after 1956 (NJ State Law requires that all students born after 1/1/1957 provide documentation of 2 (two) doses of vaccine or laboratory proof of immunity (titer) to measles, mumps and rubella as a condition of attendance at the University.)
    
  • Proof of one Mumps vaccination after age one or laboratory proof of immunity if born after 1956 (NJ State Law requires that all students born after 1/1/1957 provide documentation of 2 (two) doses of vaccine or laboratory proof of immunity (titer) to measles, mumps and rubella as a condition of attendance at the University.)
    
  • Proof of three Hepatitis B vaccines if enrolled in 12 or more credits
  • Proof of current Meningococcal Meningitis A,C,Y, & W-135 vaccination if planning to live in campus housing
  • Completion of the Information on Meningococcal Disease and Vaccination Form
  • Voluntary Immunization History:  Please include the dates for Hepatitis A vaccines, HPV vaccines and your last Tetanus vaccine (and type).
• Tuberculosis Low Risk Questionnaire (all students)

Forms to be mailed include:

• Immunization Record for Healthcare Provider(all students)
  • Proof of two Measles vaccines after age one and thirty days apart, or laboratory proof of immunity if born after 1956
  • Proof of one Rubella vaccination after age one or laboratory proof of immunity if born after 1956
  • Proof of one Mumps vaccination after age one or laboratory proof of immunity if born after 1956
  • Proof of three Hepatitis B vaccines if enrolled in 12 or more credits
  • Proof of current Meningococcal Meningitis A,C,Y, & W-135 vaccination if planning to live in campus housing (there is room on the paper form for 2 entries, you only need one CURRENT immunization)
  • Voluntary Immunization History:  Please include the dates for Hepatitis A vaccines, HPV vaccines and your last Tetanus vaccine (and type).
• Physical Examination Form (required for all CLA students; optional for Graduate, Theology and CUE students)
• Parent/Guardian Authorization for Treatment Under 18 (only for students who will not be 18 years old on arrival day)
• TB High Risk Assessment Questionnaire (if needed)

Additional special forms that must be completed on paper are available directly through links in this instruction page.  Please allow 24-72 hours to be loaded into the myhealth portal after you have registered.  If you are experiencing difficulties accessing the myhealth portal, please send an email to health@drew.edu.

Your cooperation is greatly appreciated.  For more information about health services available to Drew students please visit our website at www.drew.edu/health.

Sincerely,

Joyce L. Maglione PhD, APN, C
Director, Drew University Health Services

10 Steps to complete your Health Information for Admission

In order to complete your Admission Health Forms required to start school at Drew University, please take the following Ten steps. (Please note: the forms are in PDF format and Adobe Acrobat Reader is required).

Step One: Complete your Authorization for Treatment (if over 18 on arrival day, skip Step Two) and DUHS Notice of Privacy Practices Forms on-line at myhealth

Step Two (if you are over 18 on arrival day, skip this step and go to Step Three): Print out and complete your Parent/Guardian Authorization for Treatment Under 18 (on arrival day) with your parent or guardian and mail in with other required hard copy documents in one envelope (see Step Nine)

Step Three: Complete your Admission Health History Form on-line via myhealth

Step Four: Complete your Tuberculosis Low Risk Questionnaire Form on-line via myhealth

If you answer “Yes” to any of the questions in this questionnaire, please print out the TB High Risk Assessment Questionnaire, and complete with your Healthcare Provider.

Step Five: Print out hard copies of

1. Physical Examination Form (for all CLA, optional for Graduate and Theology admission),
2. Immunization Record for Healthcare Provider

If needed:

1. TB High Risk Assessment Questionnaire,
2. Medical Exemption,
3. Immunotherapy Treatment Plan (Allergy Shots),
4. Prescription of Restricted Medications During the School Year (e.g., Adderall, Ritalin, Concerta and other restricted medications)

Step Six: Make an appointment with your Healthcare Provider to complete the forms you have printed out above as soon as possible.

1. Physical Examination Form (for all CLA, optional for Graduate and Theology admission),
2. Immunization Record for Healthcare Provider,

If needed:

1. TB High Risk Assessment Questionnaire,
2. Medical Exemption,
3. Immunotherapy Treatment Plan (Allergy Shots),
4. Prescription of Restricted Medications During the School Year (e.g., Adderall, Ritalin, Concerta and other restricted medications)

Step Seven: Before mailing in your Immunization Record for Healthcare Provider, Form, please enter the dates of your required immunizations in the on-line form provided at myhealth

Step Eight: Special Forms for Healthcare management while attending Drew University

1. Immunotherapy Treatment Plan (Allergy Shots),
2. Prescription of Restricted Medications During the School Year (e.g., Adderall, Ritalin, Concerta and other restricted medications),
3. Medication Storage Waiver

Step Nine: Mail Your Required Hard Copy Forms to DUHS together in a single envelope

1. Physical Examination Form, (required for all CLA, optional for Graduate and Theology Admission)
2. Immunization Record for Healthcare Provider,

If needed:

1. Parent/Guardian Authorization for Treatment Under 18,
2. TB High Risk Assessment Questionnaire,
3. Medical Exemption,
4. Religious Exemption,
5. Immunotherapy Treatment Plan (Allergy Shots),
6. Prescription of Restricted Medications During the School Year (e.g., Adderall, Ritalin, Concerta and other restricted medications),
7. Medication Storage Waiver,
8. Self-Addressed Stamped envelope if you desire your documents returned to you

Detailed instructions for the 10 Steps to complete your health information for attendance at Drew University:

Step One: Complete your Authorization for Treatment and DUHS Notice of Privacy Practices Forms on-line at myhealth

If you will be 18 or older on arrival day at Drew University, complete your Authorization for Treatment Forms on-line go to the myhealth portal page to complete the on-line health data entry. If you open this site from your Drew University page, your myhealth portal page will open immediately.  Please be aware that your Drew password should be kept confidential. If you share it, others will potentially have access to your personal health information. Your required DUHS Authorization for Treatment, DUHS Notice of Privacy Practices Acknowledgements, Immunization Record, Admission Health History and Tuberculosis Low Risk Questionnaire Forms are located under “Your Forms”.

If you will be younger than 18 on arrival day at Drew University, please refer to Step Two.

The DUHS Notice of Privacy Practices acknowledgement is required by the Health Insurance Portability and Accountability Act (HIPAA) of April 2003 and we apologize for its complexity and length.  It is your right under the law to be more specific and restrictive in your authorization for the sharing of personal medical information and DUHS will make every effort to follow your wishes and directives. In order to complete this acknowledgement please review the following DUHS Notice of Privacy Practices, print and keep a copy for your records:

Drew University Health Services Notice of Privacy Practices

Step Two:  If you will be younger than 18 on arrival day at Drew University (if you are 18 or older on arrival day, skip this step)

If you will not be 18 years old or older on arrival day at Drew University, please indicate this in the correct box on-line and print out the following hard copy document for your parent or guardian to review and sign. Parent/Guardian Authorization for Treatment Under 18 Please include the signed form with your other required hard copy documents in a single envelope to DUHS by the school based date below

Step Three:  Complete your Admission Health History Form on-line via myhealth
Please answer all questions accurately.  The information you provide on this on-line form is private and confidential.  It is only available to DUHS.  This form must be completed on-line, there is no paper version available.

Step Four:  Complete your Tuberculosis Low Risk Questionnaire Form on-line via myhealth

Please complete the Tuberculosis Low Risk Questionnaire form on-line.  This form must be completed on-line, there is no paper version available.  If you answer “Yes” to any of the questions in this questionnaire, please print out the TB High Risk Assessment Questionnaire with your healthcare provider (see Step Four below).

Step Five:  Print out hard copies of the following forms that must be provided to DUHS on paper once they have been completed and signed by your healthcare provider.

1. Physical Examination Form,
2. Immunization Record for Healthcare Provider,

And, if needed:

1. TB High Risk Assessment Questionnaire,
2. Medical Exemption,
3. Immunotherapy Treatment Plan (Allergy Shots),
4. Prescription of Restricted Medications During the School Year (e.g., Adderall, Ritalin, Concerta and other restricted medications)

Step Six:  Make an appointment with your Healthcare Provider to complete the forms listed in Step Five you have printed out as soon as possible.

All of the forms listed in Step Five must be completed by your healthcare provider before sending to DUHS.

Step Seven:  Complete your Immunization History Form on-line via myhealth

Please enter the dates from the Immunization Record for Healthcare Provider, after it has been signed by your healthcare provider on-line via myhealth.  The DUHS staff will confirm your dates with your on-line Immunization Record date entry when the hard copy form been received at the DUHS office together with your other required health documents.  If you do not enter the dates from the hard copy to the on line Immunization Record form you will not be in compliance with admission requirements.  Immunization records are not private health information and are not confidential.  Immunization information is shared with the Drew University Registrar’s Office and the Housing Office.

If you have started but not yet completed your required immunizations, all needed vaccinations are available to be completed at DUHS once you are in school. If you have questions about the immunization requirements, you may call DUHS at 973-408-3414 and arrange an appointment to review your Immunization History and Immunization needs.

Step Eight:  Special Forms for your health care while attending Drew University

As part of our commitment to our Drew students,  DUHS can provide prescription and management of restricted medications, medication storage and immunotherapy administration when the appropriate forms are completed.

1. Immunotherapy Treatment Plan (Allergy Shots),
2. Prescription of Restricted Medications During the School Year (e.g., Adderall, Ritalin, Concerta and other restricted medications)
3. Medication Storage Waiver

Step Nine: Mail your required hard copy forms together in one envelope to DUHS

Mail (or hand deliver if you are already in Madison) your completed Immunization Form (with the signature of your healthcare provider), your Physical Examination (with the signature of your healthcare provider) and any other documents  to

                       Health Services, Drew University, 36 Madison Ave., Madison, NJ  07940

All Forms required on paper should be placed in single envelope.  If you would like these documents returned, please also provide a SELF-ADDRESSED, STAMPED ENVELOPE, otherwise all paper forms will be shredded after Health Services review and confirmation. 

A $10 late charge will be applied to forms received after your school’s due date, and/or forms submitted incorrectly or incomplete

We must receive these forms prior to your arrival on campus to assure that your registration goes smoothly.

Step Ten: You’re Finished!

That’s it! If you have followed the above ten steps in order, and provided DUHS with your health information and forms, you are all done! Please feel free to contact us at DUHS at (973) 408-3414  if you have questions about Health Services available at Drew University, or any of the forms or information included in your admission process. Once again, welcome to Drew University!

Yours very truly,

Joyce L. Maglione, PhD, APN, C
Director, Drew University Health Services

© 2011 Drew University, Madison, NJ
Revised 11/2011