New Student Entrance Health Forms
Due July 31, 2023

Dear Incoming Undergraduate and Graduate Students,

Welcome to Caltech! We are Student Wellness Services, and we are here to assist you during your time at Caltech by providing healthcare services, counseling services, and occupational therapy services.

Please complete the following required entrance health forms by July 31, 2023.

Required Sections and Forms that MUST be completed:

1. Complete the Health History Questionnaire.
2. Acknowledge the Treatment Agreement and Privacy Policy.
3. Complete the Tuberculosis (TB) Screening Form.
4. Upload Insurance Card: Students enrolling in the Caltech Anthem Student Advantage (ASA) insurance plan DO NOT need to complete this step.
5. Obtain the required immunizations if not received already and complete the online Immunization History Upload.

You will be dropped from your Fall classes or unable to register for classes if you do not complete the health forms. The only exceptions are if you cannot get tests/immunizations at your current location AND you communicate with Health Services about special circumstances.

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, 2023, even if you require additional testing or immunizations.

If you are unable to complete these requirements by the deadline or have any questions, contact Health Services through the Student Health Portal. Use the Messages function, and select "I want to send a message about my Health Forms, Immunizations, Medical Records" when prompted. You are responsible for communicating any delays in completing the health requirements and reading and responding to any secure messages sent to you from the Health Services Staff.

Submission of Forms and Communication Instructions: Transmission of all required documents and communication with Student Wellness Services is through our electronic medical record system on the Caltech Student Health Portal at: https://mycaltechhealth.caltech.edu/login_directory.aspx.

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 Joe Jordan, Assistant Athletic Director of Intercollegiate Operations at jjordan@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 Staff in June of each year. The physical evaluation must be completed on the Caltech-specific history and evaluation form (found in the summer Sports Med email or on the athletics website) and needs to be conducted by a medical doctor (MD) or doctor of osteopathic medicine (DO) who is licensed and in good standing in their state. The evaluation must be executed after May 1 of the year leading up to participation; older exams will not be accepted. Currently, athletic physicals cannot be completed at the Caltech Student Wellness Services. 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.

Sincerely,
John Tsai, MD
Medical Director of Health Services
Caltech Student Wellness Services

• Go to the Student Health Portal
• Log in using your Caltech access credentials
• Messages > New Message > I want to send a message about my Health Forms, Immunizations, Medical Records
• Type in your subject and message and press Send

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, 2023, 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