Health Forms

Health Records

• Immunization Records,
• Tuberculosis screening,
• Physical Exam/Health History,
• Acknowledgement of Privacy Practices (HIPAA Form).

1. All supporting documentation (PDF format preferred) MUST include a student’s full name (First name AND Last name), their date of birth and their Moody Student ID number for verification purposes.
2. Immunization Record
   • You may use this form to take to your doctor for completion OR you may submit your official, signed, up-to-date immunization record from your healthcare provider or state immunization registry.
     • Dates of immunizations will be entered by you on the Portal
     • The documentation MUST be uploaded for verification to be applied
3. Tuberculosis Screening
   • These must be completed one year before coming to campus.
   • Please answer the questions in Part 3 and follow the instructions.
   • All international students MUST complete their tuberculosis screening here on campus AFTER arrival in Chicago
   • Completed and signed form may be uploaded to Portal at this link: https://moody.medicatconnect.com
4. Physical Exam
   • Follow the instructions of the form and allow yourself time to schedule an appointment.
   • Please have the healthcare provider sign and date the form on the bottom
   • Health History MUST be completed on the Portal at this link:
     https://moody.medicatconnect.com
5. Moody Privacy Practices and HIPAA form – These MUST be completed and signed on the Portal at this link: https://moody.medicatconnect.com
6. Please follow these instructions to enter in your immunization dates, upload your forms and sign your forms and complete the requirements on the Portal.