Nyu medical clearance form 2026

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The document is a medical form from New York University School of Medicine for visiting students applying for clinical electives. It outlines the health requirements, including necessary immunizations and tests that must be completed and verified by a healthcare provider. Students must be free from communicable diseases and notify authorities if they become ill. The form includes sections for personal information, health insurance details, and specific immunization titer results.

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Click ‘Get Form’ to open the NYU Medical Clearance Form in our editor.
Begin by filling out the 'APPLICANT' section. Enter your name, date of birth, cell phone number, and address. Ensure all information is accurate and clearly printed.
Next, provide details about your medical school and type of health insurance. This information is crucial for processing your application.
Move on to the 'HEALTH CARE PROVIDER' section. For each required immunization titer, input the date of the titer and results as confirmed by your healthcare provider.
Complete all sections regarding vaccinations, including dates for Hepatitis B doses and Tuberculosis testing. Make sure to attach any necessary reports as indicated.
Finally, have your healthcare provider sign and date the form in the designated area before submitting it to avoid delays.

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Versions	Form popularity	Fillable & printable
2016	4.8 Satisfied (230 Votes)
2012	4 Satisfied (25 Votes)

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What is the medical clearance form?

The Medical Clearance Form, also known as the Mental Health Information Form, is used to establish a baseline and evaluate a Selectees ability to successfully complete 10 months in a residential service program that can be physically demanding and mentally stressful.

What are the immunization requirements for NYU?

Official record that you have received two (2) immunizations against measles, with the first one administered on or after 12 months old and the second one a minimum of 28 days later, AND at least one (1) immunization against mumps and one (1) immunization against rubella, both administered on or after 12 months old.

What does NYU require?

With a GPA of 3.81, NYU requires you to be near the top of your class, and well above average. Your transcript should show mostly As. Ideally, you will also have taken several AP or IB classes to show that you can handle academics at a college level.

Does NYU require a TB test?

TUBERCULOSIS SCREENING All entering students must have proof of tuberculosis testing within six months prior to the start of classes. A Mantoux tuberculin test (PPD test) OR an Interferon-gamma test (IGRA) lab report is required. The tuberculin skin test must be read within 48-72 hours of administration.

How do I get my medical records from NYU?

If you wish to obtain a copy of your health record, you must submit a written request to Health Information Management Services. You may use the request form Authorization for Release of Health Information (PDF 676 KB) for a printable copy. All information must be completed in order for your request to be processed.

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