About Lipscomb
Forms
Welcome to Lipscomb! In order to serve you, all students must have a Health Record Form on file in the Student Health Center.
*Pharmacy, nursing, and dietetic students must fill out the UNDERGRADUATE HEALTH FORM for correct immunization documentation.
The form must be completed on both sides. It is required prior to class registration and incomplete forms could cause a hold to go on your record until all pieces are complete.
The Health Record Form (both sides) must also be completed and submitted with the following documentation to comply with the state of Tennessee's requirements.
1. 1 st and 2nd MMR (Measles, Mumps, Rubella). You must submit copies of documentation of your first and second MMR immunizations. If you think you have had the immunizations but do not have proof, then you need to have a blood test (a titer) to see if you are immune for all three diseases. A copy of your titers is acceptable, but if you do not have acceptable levels of antibodies then you must get a MMR booster. If you were born in or before 1957, you do not need an MMR vaccination.
2. TB screening test or chest x-ray or statement of good health from your health care provider. A TB skin or blood test or chest x-ray, administered within the past 12 months, must also be submitted. If you are a returning student and have not been enrolled in school for one calendar year or more, you are required to repeat this test upon your admission. We have a TB Risk Assessment Tool if you are unsure of whether you need a TB screening test.
3. Hepatitis B vaccination A series of three (3) doses of the vaccine are required for optimal protection. Missed doses may still be sought after matriculation if only one or two have been acquired. The HBV vaccine has a record of safety and is believed to confer lifelong immunity in most cases. If a student decides to decline receipt of the Hepatitis B vaccination, then a waiver of declination must be signed.
4. Meningitis vaccination - Strongly suggested for all new residential students. If a student decides to decline receipt of the meningitis vaccination, then a waiver of declination must be signed.
*Pharmacy and Nursing Students must receive
Varicella vaccinations (series of two) or must submit proof of immunity by means of a titer. History of disease is not acceptable--a titer must be drawn.
Tetanus/diptheria vaccinations - booster must be within the past 10 years (Td or Tdap).
Tips on finding immunization records:
Please note: LU Student Health Services does NOT require a physical examination prior to admission though it is a good idea.
IMPORTANT: Failure to provide any of the items means your file is not complete and may prevent class registration!
The Health Center is located on the lower level of Elam Hall adjacent to the Counseling Center.
If you have questions, please contact the Health Center at (615) 966-6304 or 1-800-333-4358 ext. 6304 or email Melanie at melanie.stewart@lipscomb.edu. Our fax number is (615)966-5286.
You may also mail your Health Record Form to:
Lipscomb University Health Center
One University Dr.
Nashville, TN 37204
All forms require Adobe Reader to download. You may download this program for free from Adobe by clicking HERE.