Dear Incoming UC Irvine Student:

Thank you for accessing the Student Health Center New Student information via the web.

To print the required documents, please click on the links below.

(A copy of an official immunization record may be submitted as proof of compliance with the immunization requirements. If you need to visit your health care provider to obtain any immunizations, you may download this form for your provider's use.)

Vaccine Information Statements
A Vaccine Information Statement (VIS) is a document, produced by the Centers for Disease Control (CDC), that informs vaccine recipients - or their parents or legal representatives - about the benefits and risks of a vaccine they are receiving. As a patient, you should receive a VIS from your provider for each vaccine that has been recommended for you prior to receiving the vaccine. Please visit the CDC website for the Vaccine Information Statement pertaining to the specific vaccine that you will be receiving (CDC Vaccine Information Statements) as well as additional information (CDC VIS Information).
 
(Required if student will be under 18 years of age while attending UCI)


(Adobe Acrobat Reader 7.0 or higher required)

 

Your Required Actions – Please Read Carefully

  1. Logon to the secure Wellness, Health & Counseling Services Student Health Portal
    1. Select "Forms" on the left sidebar of the portal homepage.
    2. On the "Compliance Forms" page, select "High Risk Tuberculosis Screening Questionnaire". The TB Screening Questionnaire should be completed first before any other immunization information is entered. Complete the questionnaire and click on the "Submit" button.
    3. If you answered "YES" to any of the TB screening questions, then TB testing, if not already performed, is required prior to your entry to UCI. If you've already had the TB testing, then please note that it needs to have been performed within twelve (12) months prior to entry to UCI.
    4. Return to the "Compliance Forms" "page and select "Immunizations". Follow the instructions for entering your TB testing, immunization, and, if applicable, proof of immunity information. The "Required" immunizations and "Strongly Recommended" immunizations are identified respectively. After you have entered all of the requested information, upload your immunization records including lab reports of titers (evidence of immunity) and TB testing report, if applicable.
    5. Once you have completed the Immunization module, please click on the "Proceed" button to submit the information and to return to the "Compliance Forms" page to logout.
  2. Submitting your TB and immunization information electronically via the secure Student Health Portal is the strongly preferred method since the information goes directly into your personal electronic health record. However, if you are unable to logon to the portal for whatever reason, then you may download/complete/submit the Incoming Student Health Form for AY 2016-17. Follow the directions on the form and have your primary care physician complete page 2 and sign/date at bottom of the page. Submit the form to SHC Medical Records via fax or regular mail.
  3. If the required immunizations are documented on an official immunization record, a copy of the immunization record may be sent to SHC in lieu of a physician/medical professional completing page 2 of the form referenced above. However, the TB screening questionnaire on page 1 and related TB testing information on the top of page 2, if applicable, must still be completed and submitted. Foreign records must be translated into English. Please remember to include your name and student ID # on all documents returned to SHC.
  4. Return completed forms to:
    University of California, Irvine
    Attn: Medical Records Department, Student Health Center, Irvine, CA 92697-5200
    or by fax to: (949) 824-3033
    (If sending by fax, please include student's name, student ID # and "Immunization Records on the cover sheet.)