New Student Health Forms
Due July 31, 2024

We understand that for a small number of students, you may be unable to obtain the required immunizations, tests for immunity, or tuberculosis testing at your location due to the availability of vaccines or health services before you arrive on campus.

In this case, you must contact Student Wellness Services before you arrive and make an appointment at the Health Center within one week of your arrival on campus. We will help you create a plan to fulfill the requirements. While there is no charge for office visits at Student Wellness Services, vaccines, and lab tests will incur charges by the lab or pharmacy supplying these services. Student Wellness Services does not bill insurance and does not submit insurance claims on your behalf.

Non-compliance or incomplete compliance with these requirements will result in a hold on your student account through the Office of the Registrar, and you will be unable to register for classes. Exceptions to this policy are granted for limited circumstances and are generally limited to medical exemptions or exceptional circumstances where tests/immunizations are unavailable at your current location. In all circumstances, exemptions require ADVANCED communication with Health Services.

If you have questions, login, use the Messages function, and select "I want to send a message about my Health Forms" when prompted. You are responsible for reading and responding to any secure messages sent to you from the Health Services Staff.

NCAA Student-Athletes: If you plan to participate in intercollegiate athletics, you will be required to complete additional forms and a medical clearance process per NCAA bylaws. You should receive separate communication from your coach or the Caltech Athletics staff prior to August 1 with steps of how to complete the items required in order to attend any team activities. Any questions can be directed to your coach, or Carly Horchler, Assistant Athletic Director, Intercollegiate Teams, carly@caltech.edu.

Before accepting the rigors of any organized sport, student-athletes must complete a medical clearance process, including an annual Pre-Participation Evaluation by a physician. All information and instructions will be emailed to student-athletes by the Sports Medicine.

Please find additional details and the Caltech History and Evaluation Form here https://gocaltech.com/sports/2023/1/28/pre-participation-requirements.aspx

Pre-Participation Evaluations will only be valid if they are:

• Completed on the Caltech History and Evaluation Form
• Conducted by a medical doctor (MD) or doctor of osteopathic medicine (DO), licensed and in good standing in their state.
• Occurred on or after May 1 of the year leading up to participation; older exams will not be accepted.

Please contact your primary care physician or the Sports Medicine staff if you need assistance with finding a physician. Any questions about medical clearance can be directed to your coach or the Sports Medicine staff at sportsmed@caltech.edu.

Please contact IMSS for assistance with your Caltech access credentials.
Website: https://imss.caltech.edu/
Phone: (626) 395-3500
Email: help@caltech.edu

• The entrance health forms are due July 31st and are required for every incoming student.
• Student Wellness Services will make 3 attempts to reach you to assist in completing your health forms.
• It is your responsibility to check the Student Health Portal for any communications from our team.
• It is your responsibility to communicate any delays in completing your health forms to our team via the Student Health Portal.
• You will be dropped from your Fall classes or unable to register for classes if you do not complete the health forms.

• Annual Influenza (Flu) for all students
• COVID-19 vaccination for all students
• Hepatitis A for all students
• Hepatitis B for all students
• Human Papillomavirus (HPV) for all students
• Poliovirus (Polio) for all students
• Haemophilus influenza for certain students
• Jynneos (M-Pox) vaccine for certain students
• Meningitis B for certain students
• Pneumococcal for certain students
• Zooster vaccination for age 50 years or older

Please discuss with a healthcare provider if you have questions.

Resource: CDC Recommended Adult Immunization Schedule for Ages 19 and Older

• Go to Student Health Portal.
• Log in using your Caltech access credentials.
• Relevant Menu Selections:
  • Forms:
    • Health History: Enter any significant health history
    • Health Services Treatment Agreement: Acknowledge and submit
    • Notice of Privacy Practices: Acknowledge and submit
  • Messages: Attach and send your completed Tuberculosis (TB) Form or use to ask questions
  • Insurance Card: Upload your insurance card
  • Immunization History Upload: Upload your immunization records

• Found under the "Forms" menu.
• Please enter all significant past or current allergies, medications, medical conditions, family history, hospitalizations, and surgeries/procedures.

• Found under the "Forms" menu.
• Read through the Health Services Treatment Agreement.
• Acknowledge and submit your agreement.

• Found under the "Forms" menu.
• Read through the Notice of Privacy Practices.
• Acknowledge and submit your agreement.

• Download the Tuberculosis (TB) Form.
• Follow the flowchart to complete the form and gather any requested documents. TB testing, if required, needs to be dated within the last 6 months.
• Note: There is no need for additional documentation unless you are prompted for additional testing while completing the flowchart. If no additional documents are required, simply complete the first page of the TB Form and submit the form.
• Submit your TB Form on the Student Health Portal via the "Messages" menu. Create a "New Message" and select "I want to send a message about my Health Forms, Immunizations, Medical Records" when prompted. Attach your TB Form and press "Send" when you are done.
• Update 7/28/2023: Addition of Taiwan to the list of countries with high TB rates

Note: Students considering enrolling in the Caltech Anthem Student Advantage (ASA) insurance plan DO NOT need to complete this step.

• Found under the "Insurance Card" menu.
• Make a copy or take a picture of both sides (front and back) of your health insurance card.
• Use the "Add New Card" button to attach your pictures and enter the relevant information. Press "Save" when you are done.

• Found under the "Immunization History Upload" menu (not "Immunizations").
• Make copies or photos of your immunization records and any laboratory tests confirming the above immunization requirements (Accepted formats: PDF or image).
  • Please translate your records into English if your records are in another language.
• Use the "Add Immunization Records" button to upload your immunization records and any laboratory tests showing immunity.
• Press "Save" to submit your records.

If you are unable to obtain the required immunizations, tests for immunity, or tuberculosis (TB) testing at your current location, please make an appointment at Student Wellness Services within one week of your arrival on campus to have these items completed at your expense. Student Wellness Services does not bill insurance and does not submit insurance claims on your behalf. Please upload all available required forms and acknowledge the compliance forms by July 31, 2024, even if you require additional testing or immunizations.

Immunization Requirements

• Measles, Mumps, and Rubella (MMR): Two doses of measles, mumps, and rubella (MMR) vaccine OR blood test showing immunity (positive titers).
• Varicella (Chicken Pox): Two doses of varicella (chicken pox) vaccine OR blood test showing immunity (positive titer).
• Tetanus, Diphtheria, and Pertussis (Tdap): One dose of tetanus, diphtheria, and pertussis (Tdap) given after age 7. Afterward, a booster dose of tetanus and diphtheria (Td) every ten years.
• Meningococcal Conjugate ACWY (Meningitis): One dose of meningococcal conjugate ACWY (meningitis) after age 16 for all students under age 22.

Effective June 19, 2023: COVID-19 vaccination no longer required