Forms

Student Health Center

Immunization Forms

Immunization and Tuberculosis Screening Certificate

The 2017 - 2018 Immunization Certificate should be returned to the Student Health Center for the first year students by July 1st for the Fall semester and December 15th for the Spring semester.

All Medical, Nursing and GEMS (health professions) should NOT use this form and should follow the guidelines outlined in the Georgetown University School of Medicine Immunization Matriculation Requirement document or contact their respective departments for immunization requirements. In regards the the health professions students PPD requirement, a 2-step PPD-Mantoux is required and must be done within the past 12 months.  The 2nd PPD should be placed 1-3 weeks after the 1st PPD.  Quantiferon Gold or T-Spot can be done in lieu of 2-step testing.

Immunization Requirement

For public health purposes and to maintain a healthy environment for its students, faculty and staff, Georgetown University requires incoming students to provide a certification that they have received required immunizations.  District of Columbia law (D.C. Code §38-502) also requires universities to obtain immunization certifications from each student.  As described in your orientation materials, the required Immunization Form must be completed, signed by a health care provider and returned to the Student Health Center by July 1 (or by December 15 for students entering in the Spring Semester).  Failure to meet this deadline may result in a $100 fee and prevent students from registering for classes.  If, after reviewing the Immunization Form, you or your health care provider have questions, please contact the Office of Student Health at shcimmunization@georgetown.edu or 202-687-2200.

Meningitis Vaccine

Freshman living in residence halls must show proof of meningitis vaccination. You may waive this requirement by first reading the Meningitis Fact Sheet and then signing and submitting the Meningitis Vaccine Waiver form along with your Immunization and Tuberculosis Screening Certificate form.

Medical Records

Requests for medical records from the Student Health Center should be submitted on a Medical Records Request Form[m]. Once completed please fax the form to (877) 346.1469.