Medical Registration Form - Campus Health - health arizona 2025

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  1. Click ‘Get Form’ to open it in the editor.
  2. Begin by entering your legal name in the designated fields: Last, First, and Middle. Ensure accuracy as this information is crucial for your registration.
  3. Fill in your birth date and UA ID number. This helps identify you within the university system.
  4. Provide your local mailing address, including city, state, and zip code. This ensures that any correspondence reaches you promptly.
  5. Enter your home phone number and UofA status by selecting one of the options: Enrolled Student, Employee, or Visiting-Scholar/Post Doc.
  6. In the insurance section, check one box that applies to you. If you have a policyholder's information for Aetna, United Healthcare, Blue Cross Blue Shield, or Cigna, fill in those details accurately.
  7. Review all entered information for completeness and accuracy before signing and dating the form at the bottom.

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What immunizations are required for course registration? Proof of two doses of the MMR vaccine or two doses of individual Measles, Mumps, and Rubella vaccination. If you have a blood test showing immunity Measles, Mumps, and Rubella that is also acceptable.
Thirteen States that ban vaccine mandates for employees: Arizona: Ban applies to all employers except healthcare.
What immunizations are required for course registration? Proof of two doses of the MMR vaccine or two doses of individual Measles, Mumps, and Rubella vaccination.
Students entering any college or university must show proof of immunity against tetanus, diphtheria, pertussis, MMR, hepatitis B, and varicella. Students in a dormitory or comparable congregate living arrangements must have vaccination against meningococcal.
Vaccine-Specific Requirements COVID-19. Childcare and School (K12) DTaP (Diphtheria-Tetanus-Pertussis) Childcare and Elementary School. Hepatitis A. Childcare and School (K12) Hepatitis B. Childcare and School (K12) Hib (Haemophilus influenzae type b) HPV (Human Papillomavirus) Influenza. Meningococcal ACWY (MenACWY)