IMMUNIZATION FORM OVERVIEW
- The Health Center requires you to submit the completed form below (in English) no later than August 26, 2016 or you will receive a "registration block," meaning you will be unable to register for courses or adjust your course schedule.
- You may submit the form in-person at the Health Center during Clinic Times listed at the bottom of this email. Alternatively you can fax your form and copies of your medical records to 301-314-5234. Be sure your form has an email address where you can be reached.
- If you are missing records or immunizations, you may make an appointment to receive these at the Health Center upon your arrival, AFTER you first enroll in health insurance.
- Keep copies of the form and all your medical records.
- Any questions concerning the immunization requirement should be directed to the Health Center Immunization Office at 301-314-8139 or 301-314-8114.
INSTRUCTIONS FOR COMPLETING THE IMMUNIZATION FORM
Step 1: Complete Section A
Demographic information is required to be completed by every student. The address should be your address in the US. Be sure to include an email and US phone number where you can be reached by the Health Center.
Step 2: Complete Section B - Immunization for Measles, Mumps and Rubella (MMR)
The University of Maryland at College Park requires ALL incoming students to provide completed proof of two immunization dates for Measles, Mumps and Rubella (M.M.R., 2 doses) immunizations. However, a recent copy of a positive immunity lab titer report for Measles, Mumps and Rubella will be accepted in lieu of the immunization dates. A copy of the lab report must be submitted with the immunization form.
If you do not have the required MMR vaccines prior to Orientation, you will need to make an appointment to get these vaccinations prior to or during Orientation. The fee for the MMR is $72.00 USD and can be charged to your student account.
Step 3: Complete Section C - Meningococcal (Meningitis)
Completion is required by all incoming students
who will live in on-campus housing (meaning, if you live in a dorm, in a University residence hall). If you will live off-campus, this section is optional.
Step 4: Complete Section D - Tuberculosis (TB) Screening Questionnaire
Completion is required by all incoming students.
Most students who answer "yes"
to any of the questions in Section D (including ALL students who are coming from UMD's top-sending countries of China, India, South Korea, Taiwan, and Iran), will have to c
omplete an Interferon-based Assay (either a Quantiferon Gold (QFT) or T-Spot) blood test IN THE UNITED STATES and attach a copy of the official lab report to your immunization form.
- If the test is negative you do not need a chest x-ray.
- If Interferon-based Assay is positive: you must receive a Chest X-Ray. You must bring the X-Ray report (not the film) in English to the Health Center with your immunization form.
- If you do not complete the Interferon-based Assay or Chest X-Ray or do not provide results: you are required to have the Quantiferon Gold blood test at the Health Center, which costs $65.00.
Recommended (not required) immunizations for all incoming students are: Tetanus/Diptheria (within 10 years); Hepatitis B (3 doses); Meningitis (for students living off-campus); Chicken Pox (Varivax; 2 doses). They are not required for students at the University of Maryland. These Immunizations can be acquired through the University Health Center, if desired, at a later date and by appointment.
Step 6: Section F - Physician Signature or Acceptable Documentation
You must have your physician sign this form or submit the documentation outlined.
WHAT DOCUMENTS TO BRING & WHEN/WHERE TO SUBMIT
DOCUMENTS TO SUBMIT:
- Immunization Form
- Medical Records -- documentation for steps 2 and 4 (MMR and TB) in English
- Keep copies of all paperwork so that if there are any problems, you have what you need. The Health Center will keep copies of all the required items.
- Be sure the form contains contact information where you can be reached for follow-up questions because you will be notified of any problem (working email; US phone number if available).
SUBMITTING
IN PERSON**: Deliver your form in person at the Health Center (located across the street from Stamp Student Union) during specific drop-in times called "Immunization Clinics." The Immunization Clinic is staffed during the below times, so note which works best for your orientation schedule:
- Arriving before August 26? Stop by any Monday, Tuesday, Thursday, or Friday: 9:00-11:30 am.
- August 26: 9:00-11:30 am
- Undergraduate students can also drop off their immunization forms d
uring check-in at a New Student Orientation program
**If you go to the Health Center with friends, it is recommended your group be no more than ten people to avoid long wait times.
GETTING IMMUNIZATIONS AT UMD HEALTH CENTER & INSURANCE
Students who did not get immunizations or the required documentation in their country may do so at UMD.
However, you must enroll in your insurance first so the costs will be covered/reduced.
If you desire to enroll in the University-sponsored Student Health Insurance Plan (SHIP), you must be enrolled BEFORE you receive immunizations or other services at the Health Center. At time of check-in, please show the Health Center staff your insurance card or email confirmation received from United Healthcare Insurance.
This will allow the Health Center to bill properly.
To enroll in SHIP:
- Visit www.firststudent.com
- Find your school from the drop down menu at the top of the page.
- Click Enroll Now - Health Insurance (located in the red box on the left side, Student Tools)
- Click link Enroll on Line - Have your credit card ready! (near the bottom of the page under Enrollment Instructions for Voluntary Students)
*Exception: If you have a graduate assistantship, you will not enroll in SHIP and should provide insurance information from your UMD employee plan.
If you do not have insurance, you must pay out of your pocket for costs of any immunizations/tests at the Health Center. These will be charged directly to your student account for payment through the Bursar's office. Avoid this by getting insurance first!
