Health Services – High School Scholar Health Forms

Welcome HS Scholars to Bates!

Although it is not required to have a physical exam prior to attending Bates, the following forms must be submitted before the August 15th deadline. The information you provide will be 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.

Step 1: TB Screening Form

To complete the TB Screening Form, answer the five questions at the top of the form. 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 five questions you will need to submit the TB Testing Form. To submit this form, you will need to have your healthcare provider fill out the TB Testing Form with TB test results from the last 6 months.

To submit the TB Testing Form, start a new TB Testing Form using the link below and attach your completed signed TB Testing Form. If you don’t have the form or your test results electronically, you can use your phone to take a snapshot of it and attach that to the online TB Testing Form.

Step 2: Vaccine Form

To complete the Vaccine Form, you will first need to obtain a copy of your vaccination record from your healthcare provider.

Once you have your vaccination record, attach it electronically to the online Vaccine Form. Start a new electronic Vaccine Form 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. If you don’t have your vaccination records electronically you can use your phone to take a snapshot of it and attach that to the online Vaccine Form.

Check out this example of the Vaccine Form for additional help.

Health Forms – Electronic Version

	Form	Instructions
	TB Screening Form	To complete the TB Screening Form, answer the five questions at the top of the form. Please complete the form in one session as opposed to quitting out of the form otherwise you could lose the information already entered. 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. Check out this example of the TB Screening Form. Check out our Step by Step Video Guide for additional help.

Health Forms – Uploading Documents / Forms

Form

Instructions

Vaccine Form

To submit this form, you will need to have your vaccination record ready.Acceptable proof of vaccination includes: a copy of your high school vaccination record, a copy of the vaccination record from a healthcare provider’s office, or this printed vaccine form completed and signed by your healthcare provider. You can print this form below and bring it to your healthcare provider. Note: Only proof of vaccination or proof of immunity by blood titer are acceptable.

To complete this form, enter the dates of your vaccinations and upload a copy of your vaccination record. Within the electronic form you will see an icon that you can select to upload your documents. If you don’t have your record electronically, you can use your phone to take a snapshot of it and attach that to the online Vaccine Form.

Check out our “How to Attach Vaccination Records” video for further help.

TB Testing Form

This form is only required if you answered “Yes” to any of the screening questions on the TB Screening Form.To submit this form, you will need to have your healthcare provider fill out the TB Testing Form with TB test results from the last 6 months.

To complete this form, attach your completed and signed TB Testing Form. You can print this form below and bring it to your healthcare provider. If you don’t have the form or your test results electronically, you can use your phone to take a snapshot of it and attach that to the online TB Testing Form.

Check out our “How To Attach the TB Testing Form” video for further help.

Health Forms – Printable Version

Form

Instructions

TB Testing Form

Print out the TB Testing Form to bring to your healthcare provider to complete with TB test results from the last 6 months. Once this is completed, attach it electronically to the online TB Testing Form linked above.

Vaccine Form

Print out the Vaccine Form to bring to your healthcare provider to complete with your vaccine information. Once this is completed, attach it electronically to the online Vaccine Form linked above.

Acceptable proof of vaccination includes: a copy of your high school vaccination record, a copy of the vaccination record from a healthcare provider’s office, or this printed 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.

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