Health Services Forms

Although it is not required to have a physical exam prior to attending Bates, the following forms must be submitted by one of our approved methods as stated below before the July 1st deadline. The information you provide will be reviewed by Health Services staff and scanned into your secure Bates / CMMC electronic medical record. Your health information is confidential and cannot be released to anyone without your written consent.

Guidelines for helping you complete the required Health Forms.

+Health History Section
**Health History Section**

    1. When completing this section you will be asked for basic health related information. Below are some examples of the types of information required:
        • Your Personal Contact Information
        • Place of Birth
        • Parent/Guardian Contact Information
        • Personal Health History, including any chronic medical conditions, allergies, medications, and surgeries
        • Primary Care Physician

        • Checkout our FAQs for more information regarding how to complete this section.

      FAQs for Health Information


+Consent to Medical Treatment Section
**Consent to Medical Treatment Section**

      1. This section only requires a signature.


+Preliminary TB Assessment Section
**Preliminary TB Assessment Section**

  1. When completing this section, if you answer “No” to all three questions at the top of the form you can electronically sign and submit it. That’s all you need to do.
    • However, if you answer “yes” to any of the first three questions you will need to have your healthcare provider fill out the TB Assessment form.
      • If you selected “yes” as noted above, there will be a viewable link you can click on to view/print the TB form and once your healthcare provider has completed their part you can send it to us by one of two methods:
        1. Attach it Electronically to the online Upload TB Form under the Health Forms – Uploading Documents / Forms section:


Step 2: COVID-19 Vaccination Status Form / Vaccination Card

The next step involves completing the COVID-19 Vaccination Status Form and uploading a picture of your COVID-19 Vaccine Card.

      • Complete the COVID-19 Vaccination Status Form below.

    – Click on the following link, to view an example.

COVID-19 Vaccination Status form

  • Based which option you select regarding your current status, you can upload your COVID-19 Vaccination Card by attaching it to this form before submitting it.
      1. Attach it Electronically to the online “COVID-19 Vaccination Status Form below”.


Step 3: Immunization Form


The Final step involves completing the Immunization Form.

    1. You will first need to obtain a copy of your Immunizations from your healthcare provider.
    2. Once you have your immunization records you can send it to us by completing the form on the Garnet Gateway:
      1. Attach it Electronically to the online “Upload Immunization Form” under the “Health Forms – Uploading Documents / Forms section”:

Health Forms – Electronic Version

Steps
Required Form
Instructions
1
Health History, Consent to Medical Treatment and TB Form
      • Please complete the form in one session as opposed to simply quitting out of the form otherwise you could lose the information already entered. Here are some examples of the types of information you will need to complete this form:
  • Your Personal Contact Information
  • Place of Birth
  • Parent/Guardian Contact Information
  • Personal Health History, including any chronic medical conditions, allergies, medications, and surgeries
  • Primary Care Physician
  • Have you ever received treatment for latent TB?
2
COVID-19 Vaccination Status Form
  • Completing the COVID-19 Form is required. Bates College strongly urges all incoming students to be vaccinated for COVID-19. Students can demonstrate vaccinated status in either of the following ways:
  • provide proof of full vaccination and receipt of a recommended booster dose against COVID-19; or
  • provide proof of one dose of a COVID-19 vaccine since September 2022.
  • All students are required to report their COVID-19 vaccination status. Students will report their vaccination status by selecting one of the following on their first-year health forms:
  • proof of full vaccination and receipt of a recommended booster dose against COVID-19; or
  • proof of one dose of a COVID-19 vaccine since September 2022.
  • I am unable to receive recommended doses of the COVID-19 vaccine for medical reasons.
    • (Receiving a medical exemption requires approval. For more information about medical exemptions please see here.)
  • I will not receive recommended doses of the COVID-19 vaccine for philosophical reasons.
  • I will not receive recommended doses of the COVID-19 vaccine for religious reasons.

Health Forms – Uploading Documents / Forms

Forms
Required Form
Instructions
1
Upload Immunizations Form
Please make sure to have your immunization record from your healthcare provider prior to completing this step.Complete and sign the Electronic Immunization Form and submit it to Bates Health Services by July 1, 2023.

Acceptable proof of immunization includes: a copy of your high school immunization record, a copy of the original immunization certificate, a copy of your immunization record printed from your healthcare provider’s office, or a copy of the Immunization Form completed and signed by your healthcare provider. Note: Only proof of vaccination or proof of immunity by blood titer are acceptable.

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.

2
Upload TB Form
Here is where you can upload your TB form completed by your Healthcare Provider.
*Only required if you answered “yes” to any of the questions on the TB section of the “Health History, Consent to Medical Treatment and Preliminary TB Assessment Form”.

Health Forms – Printable Version

Forms
Required Form
Instructions
1 Immunizations Form Complete and sign the Immunization Form and submit it to Bates Health Services by July 1, 2023.

  1. Attach it Electronically to the online Immunization Form:
    • Start a new Electronic Immunization Form online by using the link below and attach your Immunization records to the Form. Within the electronic form you will see an icon that you can select to upload your documents.
    • Check out our “How to Attach Immunization Records” video for further help.
    • If you don’t have your immunization records electronically you can use your phone/device to take a snapshot/scan of it and attach that to the online Immunization Form.

Acceptable proof of immunization includes: a copy of your high school immunization record, a copy of the original immunization certificate, a copy of your immunization record printed from your healthcare provider’s office, or a copy of the Immunization Form completed and signed by your healthcare provider. Note: Only proof of vaccination or proof of immunity by blood titer are acceptable.

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.

2
TB Assessment Form
Complete and submit the required TB Assessment Form.
Print out the TB Form and once your healthcare provider has completed their part you can send it to us by:

  1. Attach it Electronically to the online TB Form:

Mandatory Health Insurance

Bates College requires that all students verify they have their own health insurance coverage by May 31st or be automatically enrolled in the Bates Student Health Insurance Plan.

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 May 31, 2023 will be billed for the coverage and will be automatically enrolled.

All International students & Scholars will automatically be enrolled in and billed for the Bates College 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. More information about insurance requirements for all students can be found here.

More information about financial aid and affording the cost of the Bates Student Health Insurance Plan can be found here.

We would also like to remind you to bring your health insurance card to all health related appointments at Bates Health Services to ensure access to care. Bates Health Services bills students’ health insurance.

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.