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Student Medical Report Form: Frequently Asked Questions

Where can I get a copy of the Student Medical Report Form?
Download the 2013–14 form if you are entering MIT in summer or fall 2012. Or call MIT Medical’s Health Screening service at 617-253-1777, or email medrpt@med.mit.edu.

Who must complete the Student Medical Report Form?
All incoming male and female undergraduate, transfer, graduate, and readmitted students (including military personnel), regardless of age, must complete the Student Medical Report Form.

I have waived the Student Extended Insurance Plan. Do I still have to complete the Student Medical Report Form?
Yes. All entering students must complete a Student Medical Report Form, no matter which health insurance they have.

What should I do if my physician doesn’t speak English?
You will need to have the information on the Student Medical Report Form and all your records translated into English.

Can I fax the Student Medical Report Form?
Yes. Keep the original for your records after faxing it to 617-253-4121. If the fax line is busy, please keep trying.

Can I scan my immunization records and send them attached to an e-mail?
No. Email isn’t a secure way of sending documents, and we take the confidentiality of your medical information very seriously.

What happens if I do not meet the Student Medical Report Form deadline?
Your registration will be placed on hold until we receive your completed Student Medical Report Form.

What if I am accepted to MIT after the Student Medical Report Form deadline?
You have six weeks from the date of your acceptance letter to submit your Student Medical Report Form. Please keep your acceptance letter in case we have any questions.

Do I have to pay for my pre-entry physical examination and required immunizations, or are they covered by the MIT Student Health Plan?
Yes, you must pay for them. The pre-entry physical examination, immunizations, and tests are not covered by the MIT Student Medical Plan or MIT Student Extended Insurance Plan.

I had a physical examination two years ago. Is this acceptable?
If you are entering as an undergraduate student, you must have a physical examination within the 12 months prior to your MIT registration date.

Who should sign the physical examination page of the Student Medical Report Form?
The physician or nurse practitioner who performed your physical examination must sign and date the bottom of the physical examination page. Physical exam forms signed by a student’s parent (even if the parent is a physician or nurse practitioner) are not acceptable.

What immunizations are necessary?
Please refer to page 4 of the Student Medical Report Form for a complete list and instructions. You’ll find specific requirements for measles, mumps, rubella, tetanus, diphtheria, hepatitis B, and meningococcal disease, as well as varicella (chicken pox).

What should I do if my immunization records are lost or unavailable?
You could have special blood tests called IgG titers to show immunity to measles, mumps, and rubella, a tetanus/diphtheria/pertussis (Tdap) booster, a Mantoux TB test for tuberculosis, and a hepatitis B vaccine.

My doctor says I only need one measles immunization. Is this true?
Both MIT and Massachusetts law require documented evidence of two measles immunizations, both administered after January 1, 1968, at least one month apart, and after your first birthday.

Why do I need to have two mumps vaccines?
In response to an outbreak of mumps on several college campuses in 2006, the Centers for Disease Control and Prevention and the American College Health Association have strongly recommended that students entering college have proof of two doses of a mumps vaccine or MMR (measles, mumps, and rubella) or proof of immunity through blood testing. The Massachusetts Department of Public Health has also recommended this as a way to decrease the risk of mumps among the students and others in the community in which they reside.

What's the difference between the Td (tetanus) and the Tdap (tetanus, diphtheria and pertussis) vaccines?
The Td vaccine protects you against getting tetanus and diphtheria only. The Tdap vaccine will not only protect you from those two diseases but also from pertussis (whooping cough). As a child, you may have been immunized against pertussis, but that immunity wears off over time, so by the time you enter college, you probably aren’t immune to pertussis any more. Pertussis is a highly contagious respiratory illness that often leads to other more serious illness. All entering freshman and all students in the Health Sciences and Technology program must have proof of a Tdap vaccination.

In my country, a rubella immunization is required for females only. Is this true for MIT?
Rubella immunity is required for all male and female MIT students. Regardless of your sex, you must have a rubella immunization or a blood titer that proves immunity.

Will you accept my mother’s word that I was immunized for measles, mumps, and rubella?
While your parents may be a reliable source of knowledge about your childhood health, we do require medically documented proof of immunity. Blood titers can also be used to prove immunity.

What does “documented proof” of immunity mean?
Documented proof is a written record of your immunization dates provided by a high school, university, college, or physician’s office, and/or results of laboratory blood testing.

My blood titer was equivocal or borderline. Do I need another immunization?
Yes, because we can’t accept borderline immunity. You will need another immunization to boost your immunity.

Does everyone have to have a tuberculosis (TB) test?
No. TB tests are required for students who are identified as at a higher risk. Please see the Medical Report for instructions on who needs TB testing.

Does it matter what kind of TB test I have?
If you are designated as needing a TB test, only an intermediate tuberculin 5TU PPD (Mantoux TB test) or T-Spot or a QuantiFERON-TB Gold assay blood tests are acceptable. We can’t accept multiple puncture tests such as tine, HEAF, Monovac, etc.

How should the PPD TB test reaction be documented?
TB test reaction must be documented in millimeters and signed by a physician or nurse. The reaction must be read within 48 to 72 hours after the test is administered. We cannot accept a simple reading of positive or negative.

I have received BCG in the past. Do I still need a TB test?
Yes, you still need a TB test if you fall under the high risk group (see the Medical Report Form), unless you had a previous Mantoux TB test that was positive with an indurated reaction of 10mm or greater. In that case, you must have (1) proof of a negative chest X-ray taken after your positive Mantoux, T-Spot or Quantiferon TB test, and (2) documentation that you have no symptoms of tuberculosis.

Can I have a chest X-ray instead of a Mantoux TB test?
You can only substitute a chest X-ray if a previous Mantoux TB test was positive with an indurated reaction of 10mm or greater. Otherwise, you must get a Mantoux TB test.

I am not able to get a Mantoux TB test in my country. What should I do?
Please call MIT Medical’s Health Screening service for advice at 617-253-1777, fax 617-253-4121, or email medrpt@med.mit.edu.

Do I need the hepatitis B immunization if I’m married?
Yes. The hepatitis B immunization is required by law for all newly entering undergraduate, transfer, and graduate students, regardless of age, gender, or marital status.

How many shots are there for the hepatitis B immunization?
Three. The second injection must be administered at least 28 to 60 days after the first injection. The third injection must be administered at least six months after the first injection.

Can I receive the hepatitis B shots at MIT Medical?
You should receive the first two injections before coming to MIT. If you don’t have time to complete the third injection at home, you can receive it after you arrive at MIT. Since this is a pre-entry requirement, the fee for the vaccine will not be covered by your MIT Student Health Plan.

Where can I get a Sickle Cell Trait Waiver Form?strong>
The Sickle Cell Trait Waiver form will be available for those wishing to participate on a varsity sports team via the eligibility clearance process starting in JUuly. All known participants in varsity athletics will receive an email from MIT directing them to the site once it is live. If you are not currently on a varsity roster and wish to try out, please contact the coach associated with that sport. MIT and the NCAA recommend that you are tested for Sickle cell trait by your family physician, if you are able.