Health Forms

Health Forms

Summer 2009

Dear MSSM Students and Families,

This school year is barely over and I am already planning for next year! As you probably know, students are required to undergo a complete annual medical examination PRIOR to moving into the MSSM dormitory. Each student must submit documentation of a physical exam which has been administered within the 12 months prior to the start of school. For your physician’s reference, an MSSM-approved medical evaluation form is included in this mailing. Also, I must receive an up-to-date copy of the immunization record which needs to be attached to the medical evaluation form. Please note the following changes in MSSM immunization requirements as suggested to us by the Pines Health Center.

NEW IMMUNIZATION REQUIREMENTS FOR MSSM BEGINNING IN THE 2009-2010 SCHOOL YEAR
1. MENINGITIS VACCINATION: TO BE DONE AND DOCUMENTED ON THE IMMUNIZATION RECORD BEFORE ARRIVING TO SCHOOL IN AUGUST. STUDENTS WILL NOT BE ALLOWED TO REGISTER AND CHECK INTO THE DORMITORY UNLESS THIS VACCINATION HAS BEEN GIVEN.

2. PPD TEST (FOR TUBERCULOSIS): TO BE DONE AND DOCUMENTED ON THE IMMUNIZATION RECORD BEFORE ARRIVING TO SCHOOL IN AUGUST. POSITIVE REACTIONS REQUIRE THE SCHOOL NURSE TO HAVE A CONVERSATION WITH THE STUDENT’S HEALTH CARE PROVIDER BEFORE THE STUDENT ARRIVES TO SCHOOL.

3. INFLUENZA (FLU) VACCINE (IF THERE ARE TWO, THEN BOTH ARE REQUIRED)
NOTE: THE FLU SHOT (S) WILL BE GIVEN AT SCHOOL THIS YEAR AS PART OF THE CONTRACT WE HAVE WITH THE PINES CLINIC. THE NURSE PRACTITIONER WILL COORDINATE WITH THE SCHOOL NURSE TO SET THIS UP. YOU WILL BE SENT ADDITIONAL INFORMATION IN THE FALL.

Any student who has a philosophical or religious opposition to vaccines MUST have a written letter (updated each year) from a parent or guardian which clearly outlines this stance.

Also included in this mailing, you will find our Health History form which I need to have each student and family complete. I would appreciate it very much it if you would return the Health History form by July 1st.

The physical exam and immunization record need to be sent to me as soon they are updated. It is extremely important that I have ALL of the above forms prior to registration as we will be unable to grant students admittance to their rooms until these necessary forms are submitted.

The registration process will move along more quickly and efficiently as well if all of the forms are received prior to registration. Any questions or concerns about any of the above may be directed to me at dunlapl@mssm.org.

Thank you,

Laurie B. Dunlap, BS, MS, RN