Entrance Health Forms

Completion of the entrance health forms is required for every incoming student.
Health forms are due August 15, 2021
August 17, 2021

Welcome letter is current as of 5/5/2021 and supersedes previous versions.

Dear Incoming Students of the Class of 2025 and Students of the Class of 2024 (who will be on campus for the first time),

Welcome to Caltech! We are Student Wellness Services, and we are here to assist you during your time at Caltech by providing medical care, counseling services, and occupational therapy services. Please complete the following forms by August 15, 2021. Non-compliance or incomplete compliance with these requirements will result in a CANCELLATION of your class registration for Fall 2021 through the Office of the Registrar. The only exceptions are if you cannot get tests/immunizations at your current location OR if there are special circumstances and you communicate with Health Services about those circumstances.

COVID-19 NOTICES:

The transition back to campus learning and research will occur in ways that are consistent with guidelines set by public health officials. It is the current plan that the campus will be opening to all students for Fall term 2021, Caltech is planning for the resumption of educational activities. Students who are on campus will be required to follow all Caltech procedures regarding infection prevention, vaccination, testing, isolation, and quarantine as it relates to COVID-19.

The Entrance Health Requirements and Forms are mandatory for all new incoming undergraduate and graduate students who are on campus at any time during their Caltech academic career. Even if you are uncertain when you will arrive on campus, it is advised you complete the forms now in anticipation that at a future point in time, you will come to the campus.

Due to the COVID-19 pandemic, if you are on campus, you will be REQUIRED to receive one of the COVID-19 vaccines available under the Emergency Use Authorization of the United States Food and Drug Administration. There are many benefits from COVID-19 vaccination and preventing COVID-19 is critical in the context of the COVID-19 pandemic.

Due to the COVID-19 pandemic, if you are on campus, you may be REQUIRED to receive the yearly influenza vaccine when it becomes available in the Fall of 2021. There are many benefits from influenza vaccination and preventing flu is always important, but in the context of the COVID-19 situation, it is even more important to do everything possible to reduce illnesses and preserve health care resources.

If you are unable to obtain the required immunizations, tests for immunity, or tuberculosis 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 required forms by August 15, 2021, even if you require additional testing or immunizations. Student Wellness Services staff will contact you to assist you in completing health form requirements.

Required Sections and Forms that MUST be completed:

  1. Immunization Form: On June 15, 2021, or slightly earlier, you will have access to the Caltech Student Health Portal. Please see and follow the instructions below to complete documentation for the required immunizations. Please ask your healthcare provider or your parents if you have difficulty understanding your immunization records.
  2. Tuberculosis Screening: On or after June 15, 2021, you will have access to the Caltech Student Health Portal. Please see and follow the instructions below to complete documentation for tuberculosis screening.
  3. Insurance Card: (Students enrolled in the Caltech Anthem Student Advantage (ASA) insurance plan do not need to complete this step.) Make a copy of the front and back of your health insurance card. Then follow the instructions to upload insurance card information through Caltech Student Health Portal.
  4. Health History Questionnaire: On or after June 15, 2021, you will have access to the Caltech Student Health Portal. Please see and follow the instructions below to complete the required Health History Questionnaire.
  5. Acknowledgments of Privacy Policy and Consent to Treatment: On or after June 15, 2021, you will have access to the Caltech Student Health Portal. Please see and follow the instructions below to acknowledge the required Privacy Policy and Consent to Treatment agreements.

Submission of Forms and Communication Instructions: Transmission of all required documents and communication with Student Wellness Services is done through our electronic medical record system on the Caltech Student Health Portal. Please see the instructions below on how to send a secure message and attachments to the Student Wellness Services with any questions. 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 provided a login by your sports coach to complete additional forms per NCAA bylaws. Follow the instructions sent by your coach to establish your login credentials, then click to access these forms, which are required in order to practice or attend team events. Any questions can be directed to your coach or Mark Becker, Assistant Director for Intercollegiate Operations.

Before student-athletes accept the rigors of any organized sport, their health must be evaluated by qualified medical personnel. Such an examination should determine whether the student-athlete is medically cleared to engage in a particular sport. The evaluation needs to be conducted by a medical doctor (MD) or doctor of osteopathic medicine (DO) licensed and in good standing in their state. The evaluation must be executed within the six months prior to the start of organized team activity; older exams will not be accepted. Prospective student-athletes must print and complete the "Preparticipation Physical Evaluation," found at gocaltech.com under the Athletic Training page.

Incomplete Forms: Non-compliance or incomplete compliance with these requirements will result in a CANCELLATION of your class registration for Fall 2021 through the Office of the Registrar. The only exceptions are if you cannot get tests/immunizations at your current location OR if there are special circumstances and you communicate with Health Services about those circumstances. Student Health Services staff will make three attempts to contact you regarding the completion of these required forms. If you do not complete the forms, you will be referred to the Dean's Office and the Office of the Registrar for further action. Please contact us at 626-395-6393 if you have questions or need assistance.

Deadline: The deadline to complete the above-required forms and information is August 15, 2021. Please complete the forms as best you can even you have missing items. If you are unable to obtain the required immunizations, tests for immunity, or tuberculosis 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.

Contact Us: For any questions or concerns, please contact us. You can send a secure message through the Caltech Student Health Portal or call us at 626-395-6393.

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


Completing Your Health Forms: A Step-By-Step Guide

Before You Start

  • Download the Immunization Summary Sheet. You will need to upload your original immunization records and laboratory test results online IN ADDITION to this summary sheet. Please translate your records into English if your records are in another language. Please upload all files as a PDF or image.

Your immunization documentation must meet the following requirements:

  • MMR: Two doses of measles, mumps, and rubella (MMR) OR blood test showing immunity (positive titers).
  • Chicken Pox: Two doses of varicella vaccine (chicken pox) OR blood test showing immunity (positive titer).
  • Hepatitis B: Three doses of hepatitis B vaccine OR blood test showing immunity (positive titer).
  • Tdap: One dose of tetanus, diphtheria, and pertussis (Tdap) given after age 7. Afterwards, a booster dose of tetanus and diphtheria (Td) every ten years.
  • Meningitis: One dose of meningococcal conjugate ACWY (meningitis) after age 16 for all students under age 22.
  • COVID-19: Your vaccination card should show immunization using ONE of the following:
    • Moderna (2 doses)
    • Pfizer (2 doses)
    • Johnson & Johnson / Janssen (1 dose)
    • For individuals who have been vaccinated in another country, Caltech is prepared to accept immunization records for all vaccines recognized by local public health officials, in accordance with guidance from the U.S. Centers for Disease Control and Prevention. Presently this includes vaccines authorized for use by the World Health Organization. Students may send a secure message to Student Wellness Services through the Caltech Student Health Portal for consultation on their specific circumstances.

Measles / Mumps / Rubella (MMR)

The MMR vaccine is very effective at protecting individuals against the highly contagious measles, mumps, and rubella diseases, and the serious complications that may come with these infections. Caltech requires that all new students have had a combination measles/mumps/rubella vaccine (two doses administered on or after the first birthday), or demonstrate that they have received individual vaccinations for measles, mumps, and rubella. Serologic proof (blood tests to determine immunity) are also acceptable.

[See MMR vaccine information from the CDC]

Chickenpox (Varicella)

Chickenpox, or varicella, is a highly contagious childhood disease that can be severe, or even deadly, in adults. All students must demonstrate immunity to chickenpox (through previous illness or vaccination) upon matriculation to Caltech. Those who do not have evidence of immunity should get two doses of the vaccine at four to eight weeks apart. Most people who get vaccinated will not get chickenpox if they are exposed to the disease; in cases where infection does occur, the disease is generally mild.

[See chickenpox vaccine information from the CDC]

Hepatitis B

Hepatitis B is a serious liver disease that infects an estimated 200,000 Americans each year, most of them adolescents and young adults. The U.S. Centers for Disease Control and Prevention (CDC) and the American College Health Association (ACHA) recommend that all college students get vaccinated against hepatitis B, and the National Collegiate Athletic Association (NCAA) urges vaccination for all college athletes.

The hepatitis B vaccine is 96 percent effective following a series of three shots over a six-month period.

[See Hepatitis B vaccine information from the CDC]

Tetanus / Diphtheria / Pertussis (Tdap)

New students must demonstrate that they have received a Tdap vaccine within the past 10 years.

Tetanus and diphtheria are both infections that can cause severe illness or death. Pertussis, or whooping cough, is a highly contagious respiratory disease that can spread easily among people who live in close proximity, such as in congregate living spaces.

Meningitis (meningococcal serotypes A, C, W, Y)

The CDC and the American College Health Association recommend that college students residing in congregate living environments get vaccinated to reduce their risk of meningococcal disease since they are at higher risk compared with other people of the same age.

  • The quadrivalent conjugate meningococcal vaccine (which protects against A, C, Y, and W-135 types of meningococcal bacteria) is recommended for all students between ages 16 and 21. This vaccine (given in one dose) can be their first meningococcal vaccine or (for those vaccinated as children) a booster.

COVID-19

Vaccination against COVID-19 is a critical, life-saving tool that helps protect not only the individual, but the community at large. COVID-19 is a serious disease that has killed over 3 million people worldwide since the start of the pandemic. In addition to infection control measures such as washing hands, wearing a face covering, and maintaining physical distancing, vaccination can help slow the spread of disease and the emergence of new variants of concern. The FDA has issued an Emergency Use Authorization for certain COVID-19 vaccines that have proven to be highly effective at reducing serious disease and death.

[See COVID-19 vaccine information from the CDC]


Recommended Vaccines

Flu (influenza)

The CDC recommends that everyone over the age of six months be vaccinated against seasonal flu every year. Vaccination is available in the form of both shots and nasal mist. Caltech offers free flu shots for all enrolled students, or individuals may choose to get vaccinated at one of the many local community clinics that provide flu vaccines.

[See flu vaccine information from the CDC]

Human Papilloma Virus (HPV)

Of the more than 100 strains of HPV, those of greatest concern cause genital warts and cancer. The highly effective Gardasil-9 HPV vaccination helps protect against nine types of HPV that are most often responsible for genital warts, abnormal precancerous lesions, and HPV-related cancers of the vulva, vagina, anus, penis, and oropharynx (which includes the back of the throat, base of the tongue, and tonsils).

The ACHA and CDC recommend that students receive the HPV vaccine before entering college. It is also recommended for older adolescents and young adults. It is best to be vaccinated before the first sexual contact.

[See HPV vaccine information from the CDC]

Meningitis (meningococcal serotype B)

The CDC and the ACHA recommend that college students living in residence halls or similar housing get vaccinated to reduce their risk of meningococcal disease since they are at higher risk compared with other people of the same age.

Serogroup B meningococcal vaccine series is recommended for everyone (10 years or older) who is identified as being at increased risk, either because of certain medical conditions or a local outbreak of serogroup B meningococcal disease. (Vaccination in this circumstance requires three doses, given at different times.) Adolescents and young adults (ages 16 to 23) who are not at increased risk may also choose to be vaccinated (two doses, six months apart).

[See meningococcal vaccine information from the CDC]

1) Log in and access forms

Please contact IMSS for assistance with your Caltech access credentials.

https://imss.caltech.edu/

Online: Caltech Help
Phone: 626.395.3500
Email: help@caltech.edu

Video Guide - Accessing Forms

2) Complete the Health History Form

  • Please enter all significant past or current health conditions, surgeries and hospitalizations, current medications, and allergies.

  • Make sure to press "Save Partial" if you are coming back later to finish your forms!
  • Only press "Submit Final" if you are done!

Press Save Partial to save your work and complete your form later

  • Accidentally pressed "Submit Final" before you were done? Please contact Maria Lopez at mlopez2@caltech.edu to reset your form. You will have to do the entire form again.

Video Guide - Completing the Health History Form

3) Complete the Immunization Record

  • Gather your immunization records and any laboratory tests showing immunity to the following:
    • MMR: Two doses of measles, mumps, and rubella (MMR) OR blood test showing immunity (positive titers).
    • Chicken Pox: Two doses of varicella vaccine (chicken pox) OR blood test showing immunity (positive titer).
    • Hepatitis B: Three doses of hepatitis B vaccine OR blood test showing immunity (positive titer).
    • Tdap: One dose of tetanus, diphtheria, and pertussis (Tdap) given after age 7. Afterwards, a booster dose of tetanus and diphtheria (Td) every ten years.
    • Meningitis: One dose of meningococcal conjugate ACWY (meningitis) after age 16 for all students under age 22.
    • COVID-19: Your vaccination card should show immunization using ONE of the following:
      • Moderna (2 doses)
      • Pfizer (2 doses)
      • Johnson & Johnson / Janssen (1 dose)
      • For individuals who have been vaccinated in another country, Caltech is prepared to accept immunization records for all vaccines recognized by local public health officials, in accordance with guidance from the U.S. Centers for Disease Control and Prevention. Presently this includes vaccines authorized for use by the World Health Organization. Students may send a secure message to Student Wellness Services through the Caltech Student Health Portal for consultation on their specific circumstances.

  • Download and fill out the Immunization Summary Sheet.
  • Make copies or photos of your immunization records and any laboratory tests showing immunity.
    • We accept the following file types: PNG, JPG, JPEG, GIF, PDF.
    • Please translate your records into English if your immunization records are in another language.
  • Enter the dates of vaccines or blood tests showing immunity.
  • Use the "Add Immunization Records" button to upload your immunization records and any laboratory tests showing immunity.
  • Use the "Add Immunization Records" button to upload your Immunization Summary Sheet.
Attach immunizations by pressing the "Add Immunizations Records" button

If you already hit "Submit Final" and need to submit additional immunization records, you can navigate to the Immunizations section on the sidebar and upload additional records there.

Add additional records after form completing by using the "Additional Records" button

Video Guide - Completing the Immunization Record

4) Complete the Health Services Treatment Agreement

  • Read through the Health Services Treatment Agreement.
  • Acknowledge and submit your agreement.

Video Guide - Completing the Health Services Treatment Agreement

5) Complete the Notice of Privacy Practices

  • Read through the Notice of Privacy Practices.
  • Acknowledge and submit your agreement.

Video Guide - Completing the Notice of Privacy Practices

6) Submit the Tuberculosis (TB) Questionnaire

  • Download the Tuberculosis (TB) Questionnaire.
  • 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.
  • Submit your TB questionnaire via Messages > New Message > I want to send a message about my Health Forms on the Student Health Portal.

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 Tuberculosis Questionnaire and submit the form via Messages > New Message > I want to send a message about my Health Forms.

Video Guide - Submitting the Tuberculosis (TB) Questionnaire

7) Submit a copy of your health insurance card

  • Make a copy or take a picture of both sides (front and back) of your health insurance card.
  • Submit the copies of your insurance card under the Insurance Card section of the Student Health Portal.

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

Video Guide - Submitting Your Health Insurance Card

You're done! Thank you for completing the health entrance requirements! Welcome to Caltech!


Have a question about your health forms? Send us a message on the Student Health Portal.

  • Go to Student Health Portal: https://mycaltechhealth.caltech.edu/
  • Log in using your Caltech access credentials
  • Messages > New Message > I want to send a message about my Health Forms
  • Type in your subject and message and hit Send

Video Guide - Sending a Secure Message

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