ENTRANCE HEALTH AND INSURANCE REQUIREMENTS AND REQUIRED FORMS FOR NEW AND TRANSFER STUDENTS

Dear Incoming Emory New or Transfer Student:

Welcome to Emory! We hope that your time here will be healthy, happy and always intellectually stimulating. In previous years, we have mailed health information and required health history and immunization forms to incoming students. However, we have found that these packets sometimes get lost in the mail and/or do not reach students prior to their arrival in Atlanta. In addition, some students need forms early due to medical appointments, summer travel, or the like. Therefore, we now provide these forms on-line via our Emory University Student Health and Counseling Services (EUSHCS) home web site and our confidential/secure online access to Student Health Services, Your Patient Portal, so that you can download, print and complete the forms and mail them back to us. For all new and transfer students, your Entrance Health History and your Consent for Treatment will be completed on-line via our confidential/secure Your Patient Portal system.

In order to complete your pre-matriculation Student Health forms, please take the following eight steps. (Please note: the forms are in PDF format and Adobe Acrobat Reader is required).

Step One:  Immunization Form
Step Two:  Authorization for Use/Disclosure of Protected Health Information Form
Step Three:  The State of Georgia Meningococcal Vaccination Acknowledgement Form for Students Living in On-Campus Housing
Step Four:  Complete Your Student Health Insurance Requirement Compliance Process
Step Five:  Complete Your Entrance Health History and Consent for Treatment On-Line Via Your Patient Portal
Step Six: Mail Your Forms to EUSHS
Step Seven: ADD/ADHD (attention deficit-hyperactive disorders) care for Emory students (if applicable to you)
Step Eight: You're Finished!

Step One:  Immunization Form

Your Immunization Form will be completed via Your Patient Portal at https://www.shspnc.emory.edu/login_directory.aspx. You will sign in with your standard Emory (OPUS) user ID and password. Please be aware that your Emory password should be kept confidential. If you share it, others will potentially have access to your personal health information. The Immunization form can be found under “Forms” on the left side bar. After entering the dates of your immunizations, please print your Emory University Immunization Record (found under "Immunizations" on the left side menu) and get signatures from your healthcare provider to verify the accuracy of your immunization records and, if required for your individual school/college, your tuberculosis screening records.

As you will see from the Immunization Form, you have a number of immunization series to complete (either before or after your arrival here). If you have started but not yet completed your required immunizations, all needed vaccinations are available at Emory University Student Health Services. If you have questions about the immunization requirements, you may call our Immunization Nurse at (404) 727-0392.

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Step Two:  Authorization for Use/Disclosure of Protected Health Information Form

Download the form, print and complete both pages (you might also want to make a copy for your records):

Authorization for Use/Disclosure of Protected Health Information Form

This document is required by the Health Insurance Portability and Accountability Act (HIPAA) of April 2003 and we apologize for its complexity and length. If it helps you, choosing the first option in each section of the authorization form will allow us to handle your Protected Health Information in the same confidential and concerned manner that we have always utilized in the past. However, it is your right under the new law to be more specific and restrictive in your authorization and EUSHCS will make every effort to follow your wishes and directives. In order to complete this form, your might want to review the following Emory Healthcare Notice of Privacy Practices and print and keep a copy for your records:

Emory Healthcare Notice of Privacy Practices

Step Three:  The State of Georgia Meningococcal Vaccination Acknowledgement Form for Students Living in On-Campus Housing

If you will be living in Emory on-campus housing, State of Georgia law (Official Code of Georgia Annotated 31-12-3.2) requires that you receive information about meningococcal meningitis and the vaccine and that you sign a document stating that they have either received a vaccination against meningococcal disease or reviewed the information and declined to be vaccinated. You should download, print and complete this State of Georgia form by going to:

The State of Georgia Meningococcal Vaccination Acknowledgement Form for Students Living in On-Campus Housing

To review important facts about meningococcal meningitis and meningococcal disease, you should review the following:

Important Facts About Meningococcal Disease

Step Four:  Complete Your Student Health Insurance Requirement Compliance Process

All new, transfer and continuing degree-seeking and all international Emory University students (including Oxford College) are required to have health insurance.   Under this requirement, students must either purchase the Emory University Student Health Insurance Plan (offered by Aetna Student Health) or provide documentation of enrollment in a comparable United States-domiciled plan.  For information about the Student Health Insurance Requirement, including deadline dates for your starting semester, insurance plan billing and Emory Student Health Insurance Plan annual premiums, click here.

If you wish to substitute your own insurance plan to meet this requirement, go to www.opus.emory.edu to complete the waiver process on-line.   

If a student has not waived out of the Emory Student Health Insurance Plan by the deadline date, he/she will be automatically enrolled in the annual Emory/Aetna plan for the academic year and billed by the Emory Student Financial Services (SFS). 

Students will need to complete the annual insurance enrollment/waiver process each year they are enrolled at Emory. If the student wishes to be enrolled in the Emory University Student Health Insurance Plan, that enrollment will happen automatically at the end of the waiver process.

In order for an insurance plan to meet the Emory University mandatory insurance waiver criteria, the insurance plan must feature, at a minimum, all three of the following:

1. Coverage that allows the insured student to receive outpatient, emergency, specialist and inpatient care, diagnostic testing and procedures, and mental health inpatient and outpatient care, including alcohol and substance abuse treatment, in Atlanta, GA
2. A deductible not greater than $2,500 per policy year.   If the annual deductible exceeds $2,500, the insured student must have an approved Healthcare Savings Account (HSA) that will allow the student to seek needed medical and mental health care when recommended by a healthcare provider and will cover all deductible expenses over $2,500.  
3. The insurance must be provided by an insurance company domiciled in the United States (or must be provided by an international insurance company with a United States partner for handling of insurance claims in the United States).

For information about the Aetna health insurance plan offered for Emory students click here, or go to www.aetnastudenthealth.com (click on Find Your School and choose Emory University). There is also information about insurance, EUSHS fees and billing practices on our web site click here.

Step Five:  Complete Your Entrance Health History and Consent for Treatment On-Line Via the Your Patient Portal

To complete your Entrance Health History and Consent for Treatment Forms on-line go to the Student Health Services home on our EUSHCS web page. Once there, click on the Your Patient Portal icon in the upper right corner to register. You will sign in with your standard Emory (OPUS) user ID and password. Please be aware that your Emory password should be kept confidential. If you share it, others will potentially have access to your personal health information. Your required Entrance Medical History and Treatment Agreement are located under "Forms".

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Step Six: Mail Your Forms to EUSHS

Mail (or hand deliver if you are already in Atlanta) your completed Immunization Form (with the signature of your doctor or healthcare provider), your 2-page Authorization for Use/Disclosure of Protected Health Information and your State of Georgia Meningitis Form to:

Director of Nursing Services
Emory University Student Health Services
1525 Clifton Road
Atlanta, Georgia 30322

We must receive these forms prior to the start of your classes.

Step Seven:  ADHD/ADD (attention deficit-hyperactive disorders) care for Emory students (if applicable to you)

As part of our commitment to our Emory students, their families and the Emory community at large, Emory Student Health and Counseling Services strive to be readily available to all students for mental health evaluations, crises and triage services.  In addition, we offer psychiatric services to provide evaluation, diagnosis and ongoing medication management for acute mental health disorders. Often, the management of long-standing, chronic and/or complex psychiatric conditions is beyond the scope and/or capabilities of our service, given our commitment to crisis management and timely intervention, our short-term treatment model and our available counselor/psychiatrist resources. 

Over the past decade, the number of students at Emory requesting evaluation and care for attention deficit-hyperactivity related disorders (ADHD/ADD) has escalated tremendously.  Providing services to this large and increasing volume of ADHD/ADD patients made it impossible to maintain the availability of quality psychiatric services for students with immediate mental health needs/crises, potentially putting these other high-risk patients in jeopardy.  Therefore, in Fall 2005, we made the decision no longer assume the care of new ADHD/ADD student patients at Student Health and Counseling Services, in order to maintain access for students with urgent/crisis mental health needs.  Emory students already under our care for ADHD/ADD were allowed to remain in the practice until graduation, but new patients are now referred to other psychiatric providers.

If you are a new or transfer student on ADHD/ADD medications, please contact your current physician/psychiatrist to work out a plan for ongoing care and medication once you arrive on campus. Due to the nature of the medications used for this disorder, many physicians/ psychiatrists will not prescribe for students away from home, so these students will need to be seen by a local physician/psychiatrist.  There is a list of psychiatrists and clinics in the Emory and Atlanta area that will see and treat Emory students with ADHD/ADD on our web site at http://studenthealth.emory.edu/hs/forms/adhd_list.pdf.   We recommend that you check with your insurance company to see if there are preferred psychiatric providers covered by your plan in the Atlanta area.  Please keep in mind that many area psychiatrists have a 1-3 month waiting period for a first appointment. 

While our Emory Student Health and Counseling Services counseling and psychiatry professionals will no longer treat and manage new students with ADHD/ADD themselves, they will continue to be available to students to help find appropriate evaluation and treatment resources in the Emory University area.  We thank you for your understanding in this matter.

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That's it! If you have followed the above steps, and provided Student Health Services with your health forms, you are all done! Please feel free to contact us at EUSHCS at (404) 727-7551 if you have questions about Student Health Services, the Your Patient Portal health history form, the above health forms and brochures, meningococcal meningitis and the vaccine, student health insurance and the mandatory health insurance requirement or any other student health-related issues. Once again, we welcome you into our Emory family!

Yours very truly,

Michael J. Huey, MD
Assistant Vice President and Executive Director
Emory University Student Health and Counseling Services
Clinical Assistant Professor
Department of Family and Preventive Medicine 

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© 2012 Emory University, Atlanta, GA
Revised 05/14/2012