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Immunization History Form

 


  • Confirm your N Number (including the N).


  • Go to the Forms section of the portal.


  • Click Student Immunization Form.


  • Instructions are listed at the top, followed by possible immunization history events.


  • You have an option to enter immunization history not related to compliance.
  • Entering this information is not required, but doing so will help the Student Health Center provide you with the most comprehensive care during your studies at NYU.
  • These immunizations will have Recommended next to them noted in red (as seen in the screenshot to the right).


  • If you received a vaccine, enter the date (MM/DD/YYYY) the vaccine was administered in the appropriate dose field.
  • You can type the date or use the calendar that appears when your cursor is in the date box.


  • If you have a physician diagnosed history of the relevant disease, enter the infection date in the appropriate field.


  • If you have had titers (blood tests) done to determine your immunity status, enter the date of the test in the appropriate field.
  • Then, enter the result: select “Positive” if your test result states you are immune; “Negative” if your test result states you are not immune or are equivocal.
  • You will need to upload these lab result documents at the end of the process (see below).


  • After entering your immunization information, upload your paper Student Immunization History Form that has been signed and stamped by your physician.
  • You can also upload images of other documentation supporting your immunization history (e.g. childhood vaccine books, blood test results, or other immunization records from your physician).
  • To upload a document, click the “Add immunization record...” button and select the file on your computer.
    • We accept the following file types: PNG, JPG, JPEG, GIF, and PDF. Files must be less than 4 MB in size.


  • If you started the form but need to exit and return to it later, you can click the Save Partial button at the bottom of the form.
  • Note: this will save all of the values you entered so far, but you will have to re-upload any documents.


  • Once your form is completed and you have uploaded any documents, click Submit Final.


  • After you submit your form, you can see that it was submitted successfully on the main Forms page.
  • It will have a checkmark with “Completed” and the submission date/time.
  • Note: once the NYU Student Health Center has verified that you are compliant with all immunization requirements, you will no longer see the link to the form on this page.


  • You can also view your submitted immunization information on the Immunizations page of the portal.
  • You can access this view regardless of your current immunization compliance status.


  • Sample submitted immunization that has been verified by the NYU Student Health Center based on your submitted documentation.


  • Sample submitted immunization that has not yet been verified by the NYU Student Health Center.


Meningococcal Meningitis Vaccination Response Form

 


  • Confirm your N Number (including the N).



  • Go to the Forms section of the portal.


  • Click Student Immunization Form.


  • The instructions to complete the Meningitis Vaccination Decline form are under Step 4.
  • You must download the form.


  • Please review the information from the NYS Department of Health regarding the meningococcal disease and the vaccination.


  • Once you have reviewed the information, please fill out the form.
  • Please only select one response.


  • Once you have filled out the form, you can submit it by uploading it as an attachment to the online Student Immunization form by clicking on "Add immunization record" at the bottom of the online Student Immunization form.