The Student Health Record (SHR) needs to be completed and turned in to the Health & Wellness Center on your registration day. If you have trouble completing the form, please check this web site. If you still have questions, please call (317) 788-3437 and we will assist you.
The form needs to be completed by all full time day students, those living in campus housing, and by all students in a "health career clinical field". Transfer students still need to fill out the two sides.
Athletes need to fill out a Student Health Record, and have updates to their immunizations as needed through your healthcare provider or your local health department. This form is in addition to the Athletics form. You must mail or bring in both completed forms to be compliant to practice and play on your team.
The Student Health Record is a two page form which requires a healthcare provider signature. If you have not had a well exam (physical) for more than a year, you will need one. You will need to make an appointment now to have the form filled out and get any immunization updates. If you do not have a healthcare provider, the retail health clinics (Minute Clinic, etc.) can be of assistance. Some urgent care centers also offer low rates for school physicals. Please check your local areas.
The first page gives us demographic, emergency numbers, insurance, and personal health information. Make sure you have a current medical insurance card to carry.
Please go over the last section on the first page and let us know about your health. Please list any hospitalizations, fractures, concussions, etc. This will help us in providing quality medical care. Let us know about all current medications, even if it is a vitamin or other supplement.
If you suffer from epilepsy or any seizure disorder, please send a seizure plan along with your record, or have your neurologist mail one to us. This plan includes a description of the seizure(s), what to do during and after a seizure happens, and when an ambulance is to be called whether your student is transported to a hospital or not. Some students write out this description themselves with the neurologist signing the care plan. Students need to make copies and give to the pertinent persons on campus. This includes our office, campus police, their resident director, resident assistant, all faculty, roommate(s), close friends and those sitting next to you in each class. These plans are invaluable for us and for you to continue your individual plan of care.
Page two is the immunization page. Section I (immunizations) is mandated by our state law, the Indiana State Board of Health, and by the Center for Disease Control. If you cannot get immunization information from your own healthcare provider, try your high school or your local board of health. You will need to get updates to complete the form. Again, use your own provider or your local board of health. Take what records you have with you to the appointment. The healthcare provider will sign the bottom of this page.
This completes the Student Health Record (unless you are in a Health Science program, read next section); please bring to your assigned registration day or mail to the Health & Wellness Center (Health Pavillion 108) ASAP. If you need a copy of this record, you may download from this site, complete and mail/bring in.
If you are in a graduate OT, PT, or PTA program you will also receive information with details about other lab work, CPR, etc. to be completed for your specific program. The clinical areas request more medical testing, CPR, etc. be done before you can visit any clinical site. You will need to complete the Student Health Record and do the additional requirements before your department deadline. The Student Health Record will be submitted to our office as stated above. Please make a copy to keep.
You will be given specific instructions about where to submit copies of your physical, lab results, shot records, etc. from your department. Please keep a copy of all documents for yourself as well.
MHS students will complete the Student Health Record, make a copy for yourself, and bring/mail to the Health & Wellness Center before your department deadline.
If your copy of the Student Health Record is lost, please download, complete and mail to the Health & Wellness Center (Health Pavillion 108). The Health & Wellness Center office phone number is 317-788-3437.