Medical Forms & Policies
Forms
- Medical History/Immunization Form/TB Questionnaire
- Consent to Release Information Form
- Student Health Plan
Policies
Medical History/Medical Consent
Complete the Student Information and Medical Consent sections of the Medical History Form. The Medical Consent Form grants permission from you or your parent/legal guardian (if a minor), to authorize medical treatment if needed.
Immunization/TB Questionnaire (Mandatory)
Louisiana Law (R.S. 17:170/R.S. 17:170.1/Schools
of Higher Learning) requires that all students entering Grambling State
University to be immunized for the following: Measles (2 doses), Mumps,
Rubella--required for those born on or after January 1, 1957; Tetanus-Diphtheria
(within the past 10 years); and against Meningococcal disease (Meningitis).
For more information on meningitis, click the following link: http://www.cdc.gov/meningitis/about/faq.html
The student health center is evaluating all entering students for exposure to tuberculosis (TB). Failure to return this questionnaire will result in you being placed on hold.
You will not be eligible to pay University fees until all immunization records are in compliance or the exemption is signed. Medical History/Immunization Form/TB Questionnaire.
Consent to Release Information Policy
Students may request their medical records to be released in person, by mail, or by fax. Medical records are personal and private and cannot be released without your written permission, except as required by law. Please be prepared to provide a picture ID when requesting medical records and allow five business days to process the release of medical information. Consent to Release Information Form.
Student Medical Referral Policy
Referrals can only be issued by Foster-Johnson Health Center staff and can only be used for medical consultation and treatment in Lincoln Parish. Referrals do not apply to students treated outside of Lincoln Parish and after business hours.
Students must present a validated ID card when reporting to Foster-Johnson Health Center for medical consultation and treatment.
Statement of Privacy Policies & Practices
