Forms

 

Welcome to Lipscomb! In order to serve you, all students must have a Med+Proctor account.

Effective April 1, 2018, all NEW students must submit their health forms to Med+Proctor. Please see emails you have received for further  instructions.

These must be completed. It is required prior to class registration and incomplete accounts could cause a hold to go on your record until all pieces are complete.

The account must also be completed and submitted with the following documentation to comply with the state of Tennessee's requirements.

  1. MMR (Measles, Mumps, Rubella) vaccination. Required for all students born after 1956. You must submit copies of documentation of two MMR immunizations given 4 weeks apart or 2 doses of each vaccine: measles, mumps, and rubella. 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.
  2. TB screening. Required for all students. We have a TB Risk Assessment Tool if you are unsure of whether you need a TB screening test. If any “yes” answers, one of our nurses will need to determine whether you require a TB test. All pharmacy, nursing, and dietetic students must have a TB test within the past 12 months. Talk to your program coordinator for details. A TB test can be any of the following: a PPD skin test, a Quantiferon Gold blood test, or chest x-ray administered within the past 12 months. 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.
  3. Meningitis vaccination. Required for all students living in on-campus housing given on or after age 16 and for all student nurses.
  4. Varicella. All new students born after 1979 must show proof of varicella (chickenpox) immunity through one of three ways:
    1. Proof of two (2) varicella vaccines given four (4) weeks apart.
    2. A positive titer* to varicella zoster.
    3. Documentation of varicella infection from a healthcare provider.
HEALTH SCIENCE STUDENT (Pharmacy, Nursing, and Dietetic Interns) have additional  requirements that have to be submitted to those programs only, not to Med+Proctor:
  1. 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.
  2. Hepatitis B vaccination. A series of three (3) doses of the vaccine are required for all students. Those students who are not in a health science program (pharmacy, nursing, and dietetic interns) may sign a waiver of declination. Missed doses may still be sought after matriculation if only one or two have been acquired. Pharmacy, nursing, and dietetic intern students must have the Hepatitis B series or a positive titer* (Hepatitis B Surface Antibody).
  3. Tetanus/diptheria vaccinations - booster must be within the past 10 years (Td or Tdap).

Tips on finding immunization records:

CDC—Where to find vaccine records

Please note: Lipscomb 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!

*Titers (blood tests to check immunity) can be done in a primary care clinic or the Lipscomb University Health Center. We have very competitive cash-price rates on lab tests to help students fulfill this requirement.

If you have questions, please contact us at 615.966.6304 or 800.333.4358 x. 6304 or email healthservices@lipscomb.edu. Our fax number is 615.966.5286. You may also mail your Health Record Form to:

Lipscomb University
Health Services
One University Park Drive
Nashville, TN 37204

All forms require Adobe Reader to download. You may download this program for free from Adobe.