OKWU Medical Records Process

Instructions

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  • Before filling out this form please make sure that you have:


    1. An electronic copy (PDF) of Immunization Records. 

    - Ask your doctor for Immunization Records, then scan it to PDF
    OR
    - If you cannot obtain your Immunization Records from your doctor - Fill out the Immunization Records form first to the best of your ability using the link below, then once submitted, download the form and save it to your computer. You will attach the immunization records form to this Medical Form. https://lfforms.okwu.edu/Forms/Immunization-Records
    OR
    - If your Immunization Records are in a language other than English - Fill out the Immunization Records form first using the link below, then once submitted, download the form and save it to your computer. You will attach the immunization records form to this Medical Form. https://lfforms.okwu.edu/Forms/Immunization-Records


    2. If you are an International Student, please be sure to have already taken the Tuberculosis Test. If not, please come back to this form once the test is completed and you have the results from your doctor. You will be required to bring the hard copy of the results from the doctor when you come to school.

    3. Parent's Medical Insurance Information, including the scanned copy of the Insurance Card. (if applicable).

    4. Completed "OKWU Physical Examination" and have it in electronic format (PDF) to attach to this form - you can scan it to PDF after it is completed and signed. This document MUST be filled out by your physician during or after he/she examines you. The form can be downloaded here: www.okwu.edu/physical 


Required Shots

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  • The following shots are required by the Oklahoma Wesleyan University: 
    HepB (Hepatitis B), 
    MMR (Measles Mumps Rubella)
    Meningitis

  • I have all my documents ready!

General

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Emergency Contact

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Medical Insurance

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Other

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  • Indicate any and all that apply to you.

Medical History

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  • Medical History

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Meningitis

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  • If the student received the meningitis shot before the age of 16 they will need to get a booster. If the student received the shot on or after the age of 16 they do not need to receive another shot.

  • Please see this document for more information about the Meningitis vaccine: http://www.cdc.gov/vaccines/hcp/vis/vis-statements/mening.pdf

  • Do you plan to get the Meningitis shot:

Immunization Records

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  • A copy of your immunization record is preferred. You should have already obtained a PDF of Immunization Records prior to submitting this form. 
  • Immunization Records:
  • If you cannot obtain a copy of your Immunization Records from a physician, please contact Nurse Deb.

    dcook@okwu.edu
    or
    918-335-6264
  • If your Immunization Records are in a language other than English, please click on the link below to fill out the online Immunization Records Form. The IR Form will open in a separate tab so once you submit the IR form, make sure to DOWNLOAD it to your computer and come back to this form. You will use the Upload button below to upload the form. 

  • Objection:

International Student - Tuberculosis

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  • A TB Skin Test is required for all International Students. 

    You will still be required to bring the hard copy of the results from the doctor.

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Exemption applications

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  • Please check which immunizations this exemption applies to

Medical Contraindication

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  • Reason for Objection:
    I hereby certify that the immunization(s) specified above (in Section "Exemption applications") is/are medically contraindicated for the named student.

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Religious Objection

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  • I hereby certify that immunization(s) listed below is/are contrary to the teachings of the above named student's religion. I also understand that, in the event of a disease outbreak at the Oklahoma Wesleyan University, I may have to be excluded from activities and/or classes for my protection and for the protection of the other students at the University.

Personal Objection

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  • I hereby certify that immunization(s) is contrary to my personal beliefs. I request an exemption to the immunization requirements of Oklahoma Wesleyan University. I have written a brief summary of my objections in the space provided below. I understand that lost records are not grounds for an exemption. I also understand that, in the event of a disease outbreak at the Oklahoma Wesleyan University, I may have to be excluded from activities and/or classes for my protection and for the protection of the other students at the University.

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Documents not Ready

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  • Since you are missing one or more documents to fill out this form, please come back to the form when you have the required documents. 

    Please click Submit below. You can see which documents you need to obtain in the section above. We will also email you that list with the links to the online forms that you have to fill out before filling out this form (Medical Records Form).

    If you have any questions or need help, please contact your Admission Counselor or admissions@okwu.edu  918-335-6219

Signature

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  • Date will be captured on form submission
  • OKWU only discloses personally identifiable information from a Student Health Department record to appropriate parties in connection with an emergency if knowledge of the information is necessary to protect the health or safety of the student or other individuals.
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