Health Services Forms

Although it is not required to have a physical exam prior to attending Bates, the following forms must be submitted by one of our approved methods as stated below before the July 1st deadline. The information you provide will be reviewed by Health Services staff and scanned into your secure Bates / CMMC electronic medical record. Your health information is confidential and cannot be released to anyone without your written consent.

Guidelines for helping you complete the required Health Forms.

+Health History Section
**Health History Section**

    1. When completing this section you will be asked for basic health related information. Below are some examples of the types of information required:
        • Your Personal Contact Information
        • Parent/Guardian Contact Information
        • Emergency Contact Information for at least one person
        • Place of Birth
        • Bates Email Address
        • Family Medical history
        • Personal Medical history
        • Medications
        • Hospitalizations
        • Primary Care Physician

        • Checkout our FAQs for more information regarding how to complete this section.

      FAQs for Health Information


+Consent to Medical Treatment Section
**Consent to Medical Treatment Section**

      1. This section only requires a signature.


+TB Screening Form Section
**TB Screening Form Section**

  1. When completing this section, if you answer “No” to all five questions at the top of the form you can electronically sign and submit it. That’s all you need to do.
    • However, if you answer “yes” to any of the first five questions you will need to have your healthcare provider fill out the TB Testing form.
      • If you selected “yes” as noted above, there will be a viewable link you can click on to view/print the TB Testing Form and once your healthcare provider has completed their part you can send it to us by one of two methods:
        1. Attach it Electronically to the online TB Testing Form under the Health Forms – Uploading Documents / Forms section:



Step 2: Vaccine Form


The Final step involves completing the Vaccine Form.

    1. You will first need to obtain a copy of your vaccination record from your healthcare provider.
    2. Once you have your vaccination records you can send it to us by completing the form on the Garnet Gateway:
      1. Attach it Electronically to the online “Upload Vaccine Form” under the “Health Forms – Uploading Documents / Forms section”:

Health Forms – Electronic Version

Steps
Required Form
Instructions
1
Health History, Consent to Medical Treatment and TB Screening Form
      • Please complete the form in one session as opposed to simply quitting out of the form otherwise you could lose the information already entered. Here are some examples of the types of information you will need to complete this form:
  • Your Personal Contact Information
  • Place of Birth
  • Parent/Guardian Contact Information
  • Personal Health History, including any chronic medical conditions, allergies, medications, and surgeries
  • Primary Care Physician
  • Have you ever received treatment for latent TB?

Health Forms – Uploading Documents / Forms

Forms
Required Form
Instructions
1
Vaccine Form
 Please make sure to have your vaccination record from your healthcare provider prior to completing this step. Complete and sign the electronic Vaccine Form and submit it to Bates Health Services by July 1, 2024.Acceptable proof of vaccination includes: a copy of your high school vaccination record, a copy of the original vaccination certificate, a copy of your vaccination record printed from your healthcare provider’s office, or a copy of the Vaccine Form completed and signed by your healthcare provider. Note: Only proof of vaccination or proof of immunity by blood titer are acceptable.Please note the Vaccine Form also includes recommended vaccines prior to your matriculation to Bates. We strongly recommend you receive these as well. Additional information regarding meningitis and college students is available from the Center for Disease Control and Prevention.
2
TB Testing Form
 Here is where you can upload your TB Testing Form completed by your Healthcare Provider.
*Only required if you answered “yes” to any of the questions on the TB Screening section of the “Health History, Consent to Medical Treatment and TB Screening Form”.

Health Forms – Printable Version

Forms
Required Form
Instructions
1 Vaccine Form Complete and sign the Vaccine Form and submit it to Bates Health Services by July 1, 2024.

  1. Attach it Electronically to the online Vaccine Form:
    • Start a new Electronic Vaccine Form online by using the link below and attach your vaccination records to the Form. Within the electronic form you will see an icon that you can select to upload your documents.
    • Check out our “How to Attach Vaccination Records” video for further help.
    • If you don’t have your vaccination records electronically you can use your phone/device to take a snapshot/scan of it and attach that to the online Vaccine Form.

Acceptable proof of vaccination includes: a copy of your high school vaccination record, a copy of the original vaccination certificate, a copy of your Vaccination record printed from your healthcare provider’s office, or a copy of the Vaccine Form completed and signed by your healthcare provider. Note: Only proof of vaccination or proof of immunity by blood titer are acceptable.

Please note the Vaccine Form also includes recommended vaccines prior to your matriculation to Bates. We strongly recommend you receive these as well. Additional information regarding meningitis and college students is available from the Center for Disease Control and Prevention.
2
TB Testing Form
 Complete and submit the required TB Testing Form.
Print out the TB Testing Form and once your healthcare provider has completed their part you can send it to us by:

  1. Attach it Electronically to the online TB Testing Form:

Mandatory Health Insurance

Bates College requires that all students verify they have their own health insurance coverage by May 31st or be automatically enrolled in the Bates Student Health Insurance Plan.

All Domestic students enrolled in 3 or more classes are eligible and are required to enroll or decline the Bates College Student Health Insurance Plan through their Garnet Gateway account. Students who have not made a selection by May 31, 2024 will be billed for the coverage and will be automatically enrolled.

All International students & Scholars will automatically be enrolled in and billed for the Bates College Student Health Insurance Plan.

As a college student responsible for your own health decisions, you will be primarily responsible for managing your insurance claims while you are here. To do so, it is essential to understand your policy and the specifics included within it; you may want to contact your insurance company and update them that your temporary residence will be located in Maine at Bates College. More information about insurance requirements for all students can be found here.

More information about financial aid and affording the cost of the Bates Student Health Insurance Plan can be found here.

We would also like to remind you to bring your health insurance card to all health related appointments at Bates Health Services to ensure access to care. Bates Health Services bills students’ health insurance.

We look forward to your arrival on campus this August. We are happy to answer questions about these requirements. Please contact us either by email, healthservices@bates.edu, or by calling 207-786-6199.