Health Form Checklist

This checklist is being provided to assist you in completion of your Health Center packet. Before submitting your form, please review the items below for completion:

 

______1. All required sections of the form are complete and in ENGLISH or with English translation.

______2. Proof of immunization/immunity is attached. You must provide photo copies of health documents in ENGLISH. Acceptable documentation includes: travel documents, official school record, official health department record, medical record from health care provider’s office. Alternatively, you may have your health care provider complete the immunization section of the Health History Form and sign it.  Records in a language other than English require translation into English prior to submission to the Health Center.  If you are missing documentation for the required vaccinations, you may repeat the immunization or demonstrate proof of immunity with a titer (a blood test-MMR panel).

______3. All International students must complete one of the following (please see table below):

_____   A negative IGRA blood test for TB, if test is positive I must provide a negative chest x-ray.

OR          

_____    A NEGATIVE CHEST XRAY, demonstrating that I am free from active TB.   

OR          

 _____     I will obtain a tuberculin skin test upon arrival in the United States, if test is positive I must provide a negative chest x-ray.

 

 

These reports MUST be in ENGLISH and certified by a physician. Immunization information and TB test/x-ray information must be official documents and include a health care provider’s signature.

 

Test

Where/When it can be done

Notes

Interferon Gamma Release Assay (IGRA)

 

QFT-G  or QFT-GIT

May be completed in Native country or U.S.

 Most accurate test. This test is highly recommended.

Chest X-Ray

 

May be completed in Native country or U.S.

(Required if skin test or IGRA is positive)

* A negative chest x-ray is acceptable proof of TB status  in lieu of PPD or IGRA testing

 TB (PPD) Skin Test

TB test are available at the Health Center. TB test are only available on Monday, Tuesday or Friday when undergraduate classes are in session.

 

 ONLY ACCEPTED IF COMPLETED IN THE UNITED STATES!

 Thank You for your attention to these details. If you have any questions, don’t hesitate to contact us at 219-464-5060 or by email at Health.Center@valpo.edu