New Students: Mandatory Health Clearance Forms

All health clearance documents will need to be completed and/or submitted through the ESH portal by your program's specific deadline. 

In an effort to facilitate your health clearance at future clinical sites and to fulfill the requirements of the New York State Department of Health Code 405.3, these forms must be completed and kept in your EMR at the Student Health Office.

Your record will be reviewed by Student Health clinical personnel, and if necessary, referred to the Medical Director for further evaluation prior to clearance.

Click here to access the Student Health Portal using your MyAccounts ID and password.

Complete the following documents in the portal:

• Health History
• Record of Medical Examination
  Completion of this form requires a physical examination within 6 months prior to beginning classes. All sections of this form are to be completed by your health care provider, with each item marked individually (no lines through will be accepted). The forms must be signed, dated and stamped by your health care provider and include address and phone number.
• Immunizations
  Documentation of immunity is required. Complete age appropriate vaccination records must be provided. If there is insufficient documentation, then antibody titers are required. Booster vaccine documentation is required if antibody titers are negative or equivocal.

Proof of immunity to the following is required:
Measles (Rubeola)
Mumps
Rubella
Varicella

Proof of completed Hepatitis B vaccination series (2- or 3-vaccine). Documentation of a positive antibody titer result can be provided, if available.

COVID-19 Vaccine series with current booster is Strongly Recommended.  Students going to clinical sites outside of Upstate may need proof of vaccination to meet that institution's health clearance requirements. 

While antibody titers are not required by Upstate Medical University or NYSDOH, if a well-documented record of age-appropriate vaccination is available, some external clinical sites within and outside of New York State may require antibody titers to participate in their clinical programs. You may submit evidence of these titers if you have copies of them. Fee for any titers ordered will be the responsibility of the student or billed through their health insurance provider

• Meningococcal Vaccine 
  Upload documentation of Meningococcal or Meningococcal B vaccine series completed within 5 years of orientation date OR sign waiver of vaccination on the Meningococcal Vaccine Response Form at orientation. 
• Meningococcal Vaccine Letter
• Release of Information Form for Students
• Tuberculosis Screening Test
  A tuberculosis screening test can be completed prior to arriving on campus, or performed at orientation. Acceptable screening tests are: PPD, QuantiFERON Gold, or T-Spot.  Documentation must include: date placed, date read (within 48-72 hours of placement), induration in millimeters and signed by the interpreting healthcare provider for PPD and lab report with collection date and result date for QuantiFERON Gold or T-Spot. If you have had a positive tuberculosis screening test please provide documentation of the conversion date and result/induration, chest x-ray (within 12 months), and treatment taken (drug, date started and date completed), if applicable.