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Health Insurance Acceptance/Waiver Form

Health Form & Immunization Record: Completed Health Form and Immunization Record signed by both doctor and student. The student’s healthcare provider/physician must provide accurate and legible information on the form prior to the student’s arrival at Loyola. If the student’s immunizations are not up-to-date, the student will have to receive updated immunizations in the United States for a fee. Please read the Immunizations at Ãå±±ÂÖ¼éhandout for a list of required immunizations.

Pre-Entrance Requirements

All students are required to have the following:

• Two doses of MMR vaccine:
  • Antibody blood titer tests will be accepted as proof of immunity in lieu of the above vaccinations.
• One Tetanus-Diphtheria-Pertussis (TDAP) within the past ten years.  
• Meningococcal vaccine: required by Maryland State law for all new students.
• Three doses of Hepatitis B vaccine.
• Varicella antibody titers (if no history of having chicken pox). If varicella titers are negative, we recommend the varicella vaccine.

Immunizations

All students intending to live in campus housing are required by Maryland State law to receive meningococcal vaccine.  Meningococcal Disease is a rare, but serious, bacterial infection. Because meningococcal meningitis can cause severe illness and death, early diagnosis and treatment is crucial.  Ãå±±ÂÖ¼éUniversity Student Health Center offers meningococcal vaccine to students for a fee.

For more information please consult, the Student Health website, or contact the Health Center at (410) 617-5055.