FORMS AND DOCUMENTATION
Brandies Health Center is an on-campus service to assist with meeting student health and wellness needs while at Brandeis. Incoming students are required to complete a health record before arrival to campus. This is used to assure safe and responsive treatment services and to assure we are meeting required Massachusetts state regulations. Health records are now completed at our secure online patient portal which will be available to newly enrolling students on May 6, 2017.
We recommend you bookmark the secure on-line patient portal site at https://brandeis.medicatconnect.com
HEALTH INFORMATION YOU WILL NEED PRIOR TO COMPLETING THE ON-LINE SECURE PATIENT PORTAL REQUIRED HEALTH RECORDS:
We recommend that you make an appointment with a medical provider as soon a possible to assure your records are complete and any testing or vaccinations can be completed. You will need copies of these forms to upload into the secure patient portal for your records to be complete. Incomplete records will result in a registration hold.
This form lets you know what vaccines are required before you arrive to campus. You may have your provider complete and sign this form or use the official medical records your provider gives you. You will need to enter the dates of your completed immunizations in the Secure Patient Portal and then Upload your supporting documents for validation. If you do not have your records you will need to have blood tests called titers to prove your immunity. These laboratory reports must be uploaded into the secure patient portal.
TB Screening Questionaire (*Required*) These questions will be answered in the form integrated in the secure patient portal. If yu answer yes to any of these questions you will need to have a TB screening test.
TB (Tuberculosis) Screening Test Results (*required if your questionaire is positive*) Please upload any medical TB screening tests done into the secure patient portal.
Physical Exam Please upload a copy of your latest physical exam on the secure patient portal
General Agreement Form- This *required form* is completed online through the secure patient portal and is posted here for informational purposes only.
Medical Record Release/Request Use this form to request copies of your medical records which are kept at Brandeis Health Center for 10 years.
Meningococcal Waiver Form -For students living on campus to provide informed declination of required Meningococcal vaccine (not recommended). This form must be completed on the secure patient portal.