Health Administrative Services- Medical Forms

Welcome to Kutztown University!

The KU Health Center is located on the first floor of Beck Hall and our staff is here to help keep you safe & healthy! At the Health Center students can receive care from registered nurses, physicians, certified gynecological providers, licensed mental health providers, and health education specialists without ever leaving campus! All undergraduate students pay a Health Services Fee in their semester tuition bill which allows them to utilize health services at no additional fee (minor fees may be charged to the student’s account for prescription medications and medical supplies or equipment).

To help us provide the best care possible, before you arrive to campus please log-in to your KU student health portal and complete forms related to your medical history. 

To complete your forms:

1. Using Chrome or Firefox, visit kutztown.studenthealthportal.com
2. Log-in using your myKU username and password.
3. Click on MY FORMS from the top menu.
   
   

Forms to be completed include:

1. Consent for Treatment
2. Health History
3. Immunization History
4. Insurance Form (must enter dates on this form even if you upload vaccine record)
5. Notice of Privacy Practices (FERPA)
6. Meningitis Compliance (*REQUIRED for all students living on-campus PRIOR to Move-In Day)
7. TB Screening Questionnaire
8. Communication Preferences
9. Emergency Contacts
   
   

Each form must be completed individually and submitted electronically. Additional documentation can be uploaded as needed – please do not email any medical documentation* (*unless you are an NCAA student athlete, in which case you received alternate instructions earlier this summer).

Log-in problems? Call the KU IT Department at 610-683-1511. Before contacting the IT Help Desk, please ensure you followed the instructions above!

INSURANCE INFORMATION (US citizens are not required to have medical insurance to attend KU)

If you are uninsured, the Affordable Care Act (ACA) provides many options for health insurance coverage. Visit Healthcare.gov  or call 1-800-318-2596 to see if you are eligible to enroll in a policy. Students may qualify for a subsidy to assist in payment of the premium. The window for enrollment is open in November, however, there are certain circumstances that permit enrollment anytime.

Welcome to Kutztown University!

The KU Health Center is located on the first floor of Beck Hall and our staff is here to help keep you safe & healthy! At the Health Center students can receive care from registered nurses, physicians, certified gynecological providers, licensed mental health providers, and health education specialists without ever leaving campus! All undergraduate students pay a Health Services Fee in their semester tuition bill which allows them to utilize health services at no additional fee (minor fees may be charged to the student’s account for prescription medications and medical supplies or equipment). Graduate students may opt to pay this fee so they may utilize health services as well.

To help us provide the best care possible, please log-in to your KU student health portal and complete forms related to your medical history. 

Instructions to access the online forms:

• Using Chrome or Firefox web browser, visit www.kutztown.studenthealthportal.com
• Log in with your university network email & password (same as MyKU password)
• Click on “MY FORMS” located on the top of the page

 **The below documentation must be received no later than August 14, 2024.**

 Please complete the following FORMS on your health portal:

• Immunization History – You must enter dates on this form and upload/submit official documentation for the following vaccines:
  • Tetanus, diphtheria, acellular pertussis (Tdap) – A vaccine within the past 10 years is necessary.
  • Measles, Mumps, Rubella (MMR) - 2 doses of combined or individual vaccines. Doses should be 28 days apart. Proof of immunity by blood test for measles, mumps and rubella is also acceptable.
    
    

NOTE: Students who do not submit the above vaccination records or bloodwork will be required to receive vaccinations at their own expense upon arrival to the University. Costs for these vaccinations are as follows and will be billed to your account:    Tdap - USD $65.00    MMR – USD $127.00 per dose (2 doses required)

• TB Screening Questionnaire – You must complete & submit the form(s).
  • If you answer “NO” to all the questions on TB Screening Questionnaire, submit the form – no further action is needed.
  • If you answer “YES” to any of the questions on Questionnaire, print the physician form for completion by your doctor. If you do not have your physician complete this form prior to your arrival at Kutztown University, you will be required to obtain an Interferon Gamma Release Assay (IGRA) blood test at your own expense (USD $40.00).
    
    
•  Options for Meningitis Compliance form (only required for students living on campus) You may not move onto campus if this form is not submitted.
• Consent for Treatment
• Health History
• Notice of Privacy Practices
• Insurance Form
• Communication Preferences
• Emergency Contacts
  
  

 Please feel free to contact 610-683-4082 option 2 or email medicalrecords@kutztown.edu if you have any questions.  We look forward to meeting you soon!

We recommend that you start working on these requirements as soon as  possible since you may need to visit your family doctor to complete the TB Screening and immunization requirements, and it may be helpful to have a family member assist you with purchasing health insurance.

INSURANCE:

All international students are required to maintain health insurance while attending Kutztown University. Healthcare is complicated and expensive in the United States. International students are responsible for their medical expenses. Please note that most health insurance in the U.S. does not cover all medical expenses like prescriptions, dental and vision. You may visit the websites below for plan options or call to speak to a representative. Kutztown University does not endorse and is not affiliated with any of these insurance companies.

Welcome to Kutztown University!

The KU Health Center is located on the first floor of Beck Hall and our staff is here to help keep you safe & healthy! At the Health Center students can receive care from registered nurses, physicians, certified gynecological providers, licensed mental health providers, and health education specialists without ever leaving campus! All undergraduate students pay a Health Services Fee in their semester tuition bill which allows them to utilize health services at no additional fee (minor fees may be charged to the student’s account for prescription medications and medical supplies or equipment). Graduate students may opt to pay this fee so they may utilize health services as well.

To help us provide the best care possible, please log-in to your KU student health portal and complete forms related to your medical history. 

Instructions to access the online forms:

• Using Chrome or Firefox web browser, visit www.kutztown.studenthealthportal.com
• Log in with your university network email & password (same as MyKU password)
• Click on “MY FORMS” located on the top of the page

 **The below documentation must be received no later than August 14, 2024.**

 Please complete the following FORMS on your health portal:

• Immunization History – You must enter dates on this form and upload/submit official documentation for the following vaccines:
  • Tetanus, diphtheria, acellular pertussis (Tdap) – A vaccine within the past 10 years is necessary.
  • Measles, Mumps, Rubella (MMR) - 2 doses of combined or individual vaccines. Doses should be 28 days apart. Proof of immunity by blood test for measles, mumps and rubella is also acceptable.
    
    

NOTE: Students who do not submit the above vaccination records or bloodwork will be required to receive vaccinations at their own expense upon arrival to the University. Costs for these vaccinations are as follows and will be billed to your account:    Tdap - USD $65.00    MMR – USD $127.00 per dose (2 doses required)

• TB Screening Questionnaire – You must complete & submit the form(s).
  • If you answer “NO” to all the questions on TB Screening Questionnaire, submit the form – no further action is needed.
  • If you answer “YES” to any of the questions on Questionnaire, print the physician form for completion by your doctor. If you do not have your physician complete this form prior to your arrival at Kutztown University, you will be required to obtain an Interferon Gamma Release Assay (IGRA) blood test at your own expense (USD $40.00).

 

• Options for Meningitis Compliance form (only required for students living on campus)
  • You may not move onto campus if this form is not submitted.
• Consent for Treatment
• Health History
• Notice of Privacy Practices
• Insurance Form
• Communication Preferences
• Emergency Contacts

 

Please feel free to contact 610-683-4082 option 2 or email medicalrecords@kutztown.edu if you have any questions.  We look forward to meeting you soon!

We recommend that you start working on these requirements as soon as  possible since you may need to visit your family doctor to complete the TB Screening requirement, and it may be helpful to have a family member assist you with purchasing health insurance.

INSURANCE:

All international students are required to maintain health insurance while attending Kutztown University. Healthcare is complicated and expensive in the United States. International students are responsible for their medical expenses. Please note that most health insurance in the U.S. does not cover all medical expenses like prescriptions, dental and vision. You may visit the websites below for plan options or call to speak to a representative. Kutztown University does not endorse and is not affiliated with any of these insurance companies.

If you plan to live on campus or utilize the KU Health Center you must also complete the online  Medical Forms and submit documentation for the vaccines listed below.

If Clinical Services is utilized, you will be required to pay the per semester health center fee that will be placed on your KU account when you are seen for your first appointment.

IF YOU DO NOT PLAN TO UTILIZE THE KU HEALTH CENTER OR LIVE ON CAMPUS YOU ARE NOT REQUIRED TO COMPLETE ANY FORMS FOR THE HEALTH AND WELLNESS CENTER.

If you will be residing on campus, you must complete the Options for Meningitis Compliance Form online.

If Clinical Services is utilized, you will be asked to do the following:

• Pay the per semester health center fee that will be placed on your KU account when you are seen for your first appointment.

• Complete all of the online Medical Forms.