| _____ |
Health Insurance card or copy
Check with Insurance company regarding out-of-area coverage.
UHS does not have a provider agreement with any health insurance except Student Health Insurance. We will bill your insurance but any charges not covered will be the responsibility of the patient. |
| _____ |
Immunization dates
Measles, Mumps, Rubella (MMR) - 2 doses after 1 year of age
Tetanus/diphtheria (Td) - required every 10 years
Tetanus/diphtheria/pertussis (Tdap) – one booster dose between 11-64 years of age
Hepatitis B - 3 doses
Varicella (chickenpox) 2 doses, or verification of disease
Meningitis |
| _____ |
Medication allergies |
| _____ |
Prescription medications
Enough quantity to last until returning home or home pharmacy telephone number for refills. Some pharmacies can transfer prescriptions between cities and states (Walgreen's) |
| _____ |
Telephone number of physician at home |
| _____ |
Signed parental consent for treatment if student is a minor (under 18)
Parental Consent For Treatment Form |
| _____ |
First aid supplies
(suggested items: Band-Aids, pain medication such as Tylenol or Advil, antibiotic ointment, cough syrup, alcohol wipes, and thermometer) |
| _____ |
Flu Shot
Don’t forget to obtain a flu shot or flu mist as soon as it becomes available in October. |
