2020-2021 Health Information & Immunization Form-2025

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The document outlines the Health Information & Immunization Form for Wake Forest University students for the 2020-2021 academic year. It details the legal requirements for immunization documentation, including deadlines for submission, mandatory steps to complete the form, and acceptable records of immunizations. The document emphasizes the importance of compliance with North Carolina General Statutes regarding immunizations and tuberculosis screening, as failure to meet these requirements may result in withdrawal from the university. Additionally, it provides guidelines for healthcare providers and information on various vaccines required or recommended for incoming students.
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  1. Click ‘Get Form’ to open the 2020-2021 Health Information & Immunization Form in our platform.
  2. Begin by entering your personal information, including your last name, first name, middle initial, date of birth, and Wake ID number. Ensure all details are accurate.
  3. Complete the health history section by answering questions regarding your family and personal medical history. Use the text fields to provide detailed responses where necessary.
  4. Fill out the Tuberculosis Questionnaire by responding to each question regarding TB exposure risk. This is mandatory for all incoming students.
  5. Have a healthcare provider complete the immunization record section. Ensure they sign and stamp the document for validation.
  6. Review all sections for completeness and accuracy before saving your form. Keep a copy for your records.
  7. Submit the completed form via mail or email to Wake Forest University Student Health Service as specified in the instructions.

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Using your UW user name and password login to the Patient Portal and enter your MMR dates or titer results under the Immunizations tab. Enter other immunizations and dates under the recommended section. Hit the Submit key when you have entered all your immunization information.
It depends on where you got your immunizations. If you got your shots from a: Civilian provider or pharmacy (including overseas), you must request a copy from the provider or pharmacy. Military hospital or clinic, you may get copies of your records online.
Getting a vaccine at a doctors office or health department does not require a patient-specific prescription from another health care provider.
Photocopies of immunization records from a licensed healthcare provider or clinic, or from a California K-12 school uploaded to My Health Portal. All records must show the vaccine type, dose, and date of each shot.
Should students or student health offices complete the form? Students should complete the AAMC Standardized Immunization Form in conjunction with either the student health office at their medical school or with their primary care provider.

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The date the vaccine is administered. The name, office address, title and signature (electronic is acceptable) of the person administering the vaccine. Initials of the vaccine administrator will suffice as long as the office keeps a record of the person to whom the initials refer.

Related links

Wake Forest University 2020-2021 Health Information

All Immunization records are required to be submitted in, or translated into English, and in MM/DD/YYYY format. Include name and Wake ID number on all forms.

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COVID-19 Vaccination Clinical and Professional Resources

Learn about COVID-19 vaccination, including program planning, communication and educational materials, and information about individual, approved vaccines.

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2020-21 SUSTAINABILITY OVERVIEW

Cummins worked hard to keep employees safe during the pandemic, producing 10 million masks for employee use and sponsoring vaccination clinics at several

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