Health Services Forms

Dear New Student,
From all of us at Health Services, we want to welcome you to Bates and hope you will find your experience here enriching and rewarding. Bates Health Services, in affiliation with Central Maine Medical Center (CMMC), provides medical care to students when school is in session. As you enter Bates, you are responsible for choices concerning your health, and we are here to provide important options, information, resources and medical care. We are located at 31 Campus Avenue, next to the Office of Admission. You can learn more about our services at Bates Health Services.

You must complete the required forms from the checklist below by July 1st. These required Health Forms can be found on the Entering Student Information pages within the Garnet Gateway website. It is not necessary to have a physical exam prior to attending Bates; however, the following forms must be submitted securely online before the July 1st deadline. The information you provide will be scanned into your secure Bates / CMMC electronic medical record. Your health information is confidential and cannot be released to anyone without your written consent.

Students under age 18, when completing The CMMC Authorization form, are required to have a parent/guardian signature. Once a student turns 18 they may update their health information/authorization forms with their signature at Bates Health Services.

Here are some guidelines for helping you fill out the Health Forms:

  • Review the Health Forms FAQs so you will know what type of information is required before starting the process.
      – Listed below are just a few examples, review the full list here: Health Forms FAQs
        Insurance Card
        Medical history
        Medications you’re currently taking
        Official Immunization Record from your physician’s office or from your high school
  • Decide which option you prefer to use to fill out your health forms:
    • Option 1: Electronic Version (Preferred Method)
    • Option 2: Print and Dropoff, Mail, Fax or Email
  • Take a look at some of the Examples to help guide you
  • If you need further help, Health Services can help.

  • “Finish Later” Feature
      – The ability to “Finish Later” has been implemented.
        You will be asked to verify your email address
        A security code will be sent to your email address
        Within that message you will have a link that will allow you to continue to edit your forms.

Health Forms – Electronic Version

Required Form
Instructions
Support Materials / Examples
First Year Electronic Health Form

Health Forms – Printable Version

Forms
Required Form
Instructions
Support Materials / Examples
1
CMMC Authorization Form
Complete and Sign – This form enables us to establish a medical record file for you and will facilitate the process of signing in for medical appointments when you are on campus.

2
Pre-Registration Form for CMMC
Complete and Sign – This form enables us to establish a medical record file for you and will facilitate the process of signing in for medical appointments when you are on campus.

3
Health History Form
Complete and Sign – Please be sure to include any information about chronic illnesses, recent hospitalizations, allergies and medications.

4
Immunizations Form
Complete and sign the Immunization Form and email healthservices@bates.edu, mail or fax (207-786-8240) a copy of proof of immunization by July 1, 2017.

Acceptable proof of immunization includes: a copy of your high school immunization record or a copy of the original immunization certificate. Note: Only proof of vaccination or proof of immunity by blood titer are acceptable.

All college students in Maine are required to show proof of immunity to measles, mumps and rubella with documentation of two doses of MMR after the first birthday or with immune titer lab results for each disease. Additionally, students must show documentation of a tetanus/diphtheria booster within 10 years prior to enrollment. Where an immunization exemption has been previously granted, the written request, Bates Immunization Exemption Form, for exemption must be sent to Bates Health Services to become part of the school health record. In the event that a communicable disease, such as measles, mumps, or rubella is identified on campus, students who are not immune from that disease shall be excluded from school for one incubation period following the latest case of the disease. If a previously non-immune student then receives MMR immunizations following the identification of a disease on campus, this student must wait one incubation period following completed MMR immunization before returning to school. Please note, incubation periods vary based on disease type and “completed MMR immunization” is defined as 2 doses of MMR separated by 28 days after the first birthday.

Please note the Immunization Form also includes recommended vaccines prior to your matriculation to Bates. We strongly recommend you receive these as well. Additional information regarding meningitis and college students is available from the Center for Disease Control and Prevention.

5
Preliminary TB Assessment Form
Complete and submit the required TB Assessment Form. If all answers are No to the first three questions, sign and submit the form. Any YES answer requires your physician to complete the printed form and either email it to healthservices@bates.edu, mail or fax (207-786-8240) it to Bates Health Services (31 Campus Ave. Lewiston, ME 04240) by July 1st.

Mandatory Health Insurance

Bates College requires that all students verify they have their own health insurance coverage by July 30th or be automatically enrolled in the Bates Student Health Insurance Plan. As a college student responsible for your own health decisions, you will be primarily responsible for managing your insurance claims while you are here. To do so, it is essential to understand your policy and the specifics included within it; you may want to contact your insurance company and update them that your temporary residence will be located in Maine at Bates College. We would also like to remind you to always have your insurance/prescription cards on hand and bring them with you to all health related appointments at Bates Health Services.

All Domestic students enrolled in 3 or more classes are eligible and are required to enroll or decline the Bates College Student Health Insurance Plan through their Garnet Gateway account. Students who have not made a selection by June 30, 2017 will be billed for the coverage and will have until July 30, 2017 to have the charge removed by declining coverage. After July 30, 2017 any student who has not declined the insurance will automatically be enrolled.

All International students & Scholars will automatically be enrolled in and billed for the Bates College Student Health Insurance Plan.

We look forward to your arrival on campus this August. We are happy to answer questions about these requirements. Please contact us either by email, healthservices@bates.edu, or by calling 207-786-6199.