Clinical Health Care Services

• Medical Exemption Statement Form
• 
  Revised Medical Exemption Statement and Physician’s Request for Medical Exemption Forms Memo
• 
  Physician’s Request for Medical Exemption
  
• Release of Information Form
• Meningococcal Vaccination Waiver
• Immunization Record & Medical History Form

Are You In Compliance?

North Carolina State law (General Statue 130A 152-157) requires that ALL new (undergraduate and graduate) students enrolling in college at any time during the year present documented proof of immunizations. If you are taking 4 or more credit hours on the main campus before 5:00 p.m., you must sign into your HIPAA protected https://uncfsu.medicatconnect.com/ to complete your online health history forms and upload your immunization records.

Immunizations are required by the state of North Carolina and must be physician-certified or verified by a clinic stamp before registering at FSU. Failure to comply with mandatory state immunization laws requires administrative withdrawal from the University.

Exemption from immunization requirements include:

• (a) Students enrolled for four credit hours or less and residing off campus.
• (b) Students attending in the evening (starting at 5:00 pm).
• (c) Student taking weekend classes only.
• (d) Students taking off campus classes for the duration of their degree program.

Required Immunizations

The North Carolina Department of Health and Human Services answers questions about College and University immunization requirements.

• Tetanus: 3 doses from anytime in your life. The following also applies:
  • A dose of a tetanus vaccination containing pertussis is required after age 10.
    • The usual abbreviation for the adult tetanus, diphtheria and pertussis (whooping cough) vaccine in the US is Tdap.
    • Brands in the USA: Boostrix and Adacel (Also Revaxis in Europe)

Measles: 2 doses given after the student’s first birthday and at least a month apart.

Mumps: 2 doses given after the student’s first birthday and at least a month apart.

Rubella: 1 dose after the student’s first birthday.

• An official lab report may be substituted for the measles, mumps or rubella requirements.
  • This lab report should contain: See above for the requirements on an official lab report

Hepatitis B: 3 doses are required for students born after June 30, 1994.

• NC law does not allow a lab report showing immunity to fulfill this requirement.
• Dose #3 should be administered after 6 months of age
• The preferred schedule for these is at day 0, 1 month and 6 months

Polio: 3 doses. This applies only if the student is younger than 18 years of age.

Varicella: 1 dose given after the student’s first birthday for individuals born after April 1, 2001.

• An official lab report may be substituted for the Varicella requirement.
• This lab report should contain: See above for the requirements on an official lab report

Tuberculosis: (Only for International Students) One of the following within 12 months prior to the first day of class is indicated to fulfill this requirement:

• A negative tuberculosis skin test (TST), recorded in mm.
• Official lab report of a negative IGRA (Interferon-Gamma Release Assay)(QuantiFERON gold)
  • See above for the requirements on an official lab report
• A radiologist report of a Chest X Ray indicating no signs of active or latent tuberculosis.
  • See above for the requirements on an official lab report.

Recommended Immunizations

• COVID-19 vaccine
• Meningococcal vaccine
• Meningococcal B vaccine
• Hepatitis A
• Human Papillomavirus

Immunization Records

Immunization records need to include the following:

• Your name
• FSU Banner ID number
• Your date of birth (month/day/year format)
• The name, address and phone number of the doctor’s office providing the record.
• The month/day/year of the immunization received

Lab Reports and Radiology Report

Lab reports and radiology reports may be used to complete some requirements. If a lab report is submitted, then an official and complete report from the laboratory or the radiologist is necessary.

• These are generated from the lab or the radiologist
• They contain your name, birth date, the name address and phone number of the lab/radiologist.
• Lab work must contain numeric values for the normal range of the lab result
• Lab work must contain the numeric value for the patient’s lab result.

Diphtheria, tetanus and pertussis

Three doses are required for individuals entering college or university. Individuals entering college or university for the first time on or after July 1, 2008, must have had three doses of tetanus/diphtheria toxoid; one of which must be tetanus/diphtheria/pertussis.

Polio

Three doses are required for individuals entering college or university. An individual attending school who has attained his or her 18th birthday is not required to receive polio vaccine.

Measles

Two doses at least 28 days apart are required for individuals entering college or university. The requirement for a second dose does not apply to individuals who entered school, college or university for the first time before July 1, 1994. A person who has been diagnosed prior to January 1, 1994, by a physician (or designee such as a nurse practitioner or physician’s assistant) as having measles (rubeola) or an individual who has been documented by serological testing to have a protective antibody titer against measles is not required to receive measles vaccine. Individuals born before 1957 are not required to receive measles vaccine except in measles outbreak situations.

Mumps

Two doses are required for individuals entering college or university. A physician's diagnosis is not acceptable for mumps disease(s). Individuals must be immunized or have laboratory confirmation of disease or have been documented by serological testing to have a protective antibody against mumps. Individuals born before 1957 are not required to receive the mumps vaccine.  Individuals that entered college or university before July 1, 1994, are not required to receive the vaccine. Individuals that entered school, college, or university before July 1, 2008, are not required to receive the second dose of mumps vaccine.

Rubella

One dose is required for individuals entering college or university. A physician's diagnosis is not acceptable for rubella disease(s). Individuals must be immunized or have laboratory confirmation of rubella disease or have been documented by serological testing to have a protective antibody titer against rubella. Any individual who has attained his or her fiftieth birthday is not required to receive rubella vaccine except in outbreak situations. Any individual who entered college or university after his or her thirtieth birthday and before February 1, 1989, is not required to receive rubella vaccine except in outbreak situations.

Hepatitis B

Three doses are required for individuals entering college or university. Hepatitis B vaccine is not required if an individual was born before July 1, 1994.

Varicella

One dose is required for individuals entering college or university that were born on or after April 1, 2001. An individual who has laboratory confirmation of varicella disease immunity or has been documented by serological testing to have a protective antibody titer against varicella, or who has documentation from a physician, nurse practitioner, or physicians' assistant verifying history of varicella disease is not required to receive varicella vaccine. The documentation shall include the name of the individual with a history of varicella disease, the approximate date or age of infection, and a healthcare provider signature. Individuals born before April 1, 2001, are not required to receive varicella vaccine.

Meningococcal

One dose is required for individuals entering the seventh grade or by 12 years of age, whichever comes first, on or after July 1, 2015. A booster dose is required for individuals entering the 12th grade or by 17 years of age, whichever comes first. Individuals who entered seventh grade before July 1, 2015 are not required to receive the first dose. The booster dose does not apply to individuals who entered the 12th grade before August 1, 2020. If the first dose is administered on or after the 16th birthday, a booster dose is not required. Individuals born before January 1, 2003 shall not be required to receive meningococcal conjugate vaccine.

Medical Exemption 

G.S.130A-156. Medical exemption.

The Commission for Public Health shall adopt by rule medical contraindications to immunizations required by G.S. 130A-152. If a physician licensed to practice medicine in this State certifies that a required immunization is or may be detrimental to a person's health due to the presence of one of the contraindications adopted by the Commission, the person is not required to receive the specified immunization as long as the contraindication persists. The State Health Director may, upon request by a physician licensed to practice medicine in this State, grant a medical exemption to a required immunization for a contraindication not on the list adopted by the Commission.

Medical exemptions can only be requested by a physician licensed to practice medicine in North Carolina. If a physician determines the need to request a medical exemption from a required immunization for a patient and needs assistance, they should contact the North Carolina Immunization Branch at (919) 707-5550.

• (08/03/2020)Revised Medical Exemption Statement and Physician’s Request for Medical Exemption Forms Memo
• Medical Exemption (PDF, 170 KB) (DHHS 3987)

Use this form for true contraindications, i.e. those recognized by the Commission for Public Health.

• Physician’s Request for Medical Exemption (PDF, 136 KB) (DHHS 3995)

Use this form for contraindications not recognized by the Commission for Public Health.

Steps for Immunization Compliance

STEP 1: Log into the Student Health Patient Portal.

STEP 2: Complete the online fillable forms within Patient Portal.

STEP 3: Have a doctor’s office, clinic or health department complete the correct Mandatory Immunization Requirements Form below. Forms cannot be signed by family members.

University Immunization Requirements for Students

STEP 4: Click on the Immunization Requirements Form update button and upload your signed Mandatory Immunization Form (along with any additional testing or documents if applicable).

STEP 5: Monitor your Bronco Email. Communications regarding your compliance status can be found by logging into the Student Health Portal and clicking on “Messages” on the left tool bar. Your Broncos email will notify you when a new message has been sent.

Deadline to submit Immunization Requirements

• Fall Semester: June 15
• Spring Semester: December 15
• Summer Semester: May 1

Acceptable Forms of Immunization Records

If you already have a copy of your immunization records that is stamped or signed by the administering physician/health agency and includes dates on which immunizations were administered, you can use this as proof of your immunizations. Please include your name, student identification number, and date of birth on all pages uploaded.

You may print a copy of the Immunization Form and submit it to your physician to complete and sign. You may download this form from the Forms Library. If you would prefer you may call to have this form mailed to you.

For transfers, if you have attended another college or university that also required immunizations, contact the former university's health center to request that a copy of your records be sent to you (preferably) or to the FSU Student Health Center. Your immunization records do not transfer automatically.

ALWAYS KEEP A COPY OF ANY RECORDS SUBMITTED FOR REVIEW; IT IS IMPORTANT THAT YOU MAINTAIN YOUR OWN MEDICAL RECORD OF VACCINES RECEIVED

The UNC System Student Health Insurance Plan (SHIP) premium will appear on your student account once you register for courses and if you meet all of the invoking criteria. The premium can be removed from the account by submitting an online waiver by the posted deadline.  Be aware that if you fail to waive coverage, the premium for SHIP is non-refundable after the posted deadline each semester. If you wish to enroll in University Student Plan , we encourage you to do so during open enrollment. This ensures you will receive an insurance card as quickly as possible.

Please note, if you neither waive nor enroll in SHIP by the posted deadline, you will automatically be enrolled after the posted deadline.

Waive/Enrollment Dates: 

Spring November 1, 2023 – January 31, 2024

Fall May 11, 2024 – September 11, 2024

Health Insurance premiums are not included in the total cost of attendance. Students who purchase SHIP may contact their financial aid counselor to request the expense be included in their individual cost of attendance.

Medically necessary services, rendered by Student Health Service providers, are covered 100% (no copayment, no deductible) with the Student Blue Health Insurance Plan. Prescriptions filled by Student Health Pharmacy are covered with a $15 co-payment per prescription or refill.

Student Insurance

Fayetteville State University requires each student to have accident and sickness insurance protection either by their personal policy or under the FSU Student Medical Insurance Plan. The premium for the University Sponsored Insurance Plan is $1,392.40, this charge is included in the student’s bill each semester. All F1 & J1 Visa International students are required to have health insurance while attending FSU.

To waive / enroll in the Student Health Insurance Plan, students must complete the online process at http://studentbluenc.com/#/fsu/welcome. Additional information describing the Student Insurance Benefits Plan is available at the above website. Students who do NOT wish to be enrolled in the Student Insurance Plan MUST complete the insurance waiver form online prior to the deadline date each semester after enrolling in classes.

THE DEADLINE TO WAIVE/ENROLL IN STUDENT BLUE HEALTH INSURANCE IS;

Spring Semester: January 31, 2024

Fall Semester: September 11, 2024

Insurance Requirement

How and When to Enroll or Waive

Students are required to have health insurance. Students may remain on their parents’ insurance or buy their own insurance. Students must provide proof of insurance by submitting an on-line waiver. Students without insurance may purchase and enroll in the Student Blue Student Health Insurance.

Fall 2023 and Spring 2024 Student Blue Health Insurance premium is $1,392.40.

For the most up-to-date status of your waiver request, refer to recent emails from Student Blue and Student Health Insurance Dept.

Please read all emails. Emails will be sent to the student’s uncg.edu email address. Student Blue has the option for you to have a secondary email address, such as a parent’s address.

International Student Insurance Requirements

All F1 & J1 Visa International students are required to have health insurance while attending UNC Greensboro. Students may enroll into the Student Health Insurance Plan or they may enroll in another US or home country plan that meets the University’s minimum health insurance requirements. In order to waive the Student Health Insurance Plan, students must complete the online waiver form with Blue Cross Blue Shield. 

Your health plan must meet the following minimum requirements:

• Minimum total benefit/coverage of $100,000 (USD) per accident or illness
• Plan deductible of no more than $500 (USD)
• Minimum of $50,000 (USD) for medical evacuation
• Minimum of $25,000 (USD) for repatriation coverage
• Policy must be active for the entire duration of the academic semester.

**Important notice regarding non-US health insurance plans. After completing the online insurance waiver you will be required to send a copy of your policy declaration page for review. All information must be submitted in English and all of the benefits and exclusions of the plan must be clearly stated. If the policy does not meet the minimum requirements and/ or it is not completely in English, the waiver will automatically be declined and students must purchase the University sponsored plan.

Who is Required to have Health Insurance 

The following Fayetteville State students are required to have health insurance and are automatically charged the current semesterly premium amount for the Student Health Insurance Plan (SHIP) when they register for the semester. You must provide proof of insurance on-line at the Student Blue link above in order to waive the premium:

Undergraduate Students are eligible if:

• Enrolled in a degree-seeking program, and
• Enrolled in six (6) or more on campus credit hours, and
• Enrolled student regardless of # of hours living in Housing & Residence Life Unit, and
• Eligible to pay the university Student Health Fee

Graduate Students:

• Enrolled in a degree-seeking program, and
• Enrolled in six (6) or more on campus credit hours, and
• Enrolled student regardless of # of hours living in Housing & Residence Life Unit, and
• Eligible to pay the university Student Health Fee

Special Populations

Veterans:

• Enrolled in 6 or more credit hours in a degree-seeking on-campus program or major.

Study Abroad, Co-op, and Student Interns:

Degree-seeking students participating in a UNC system campus-sponsored study abroad program, are eligible for, but are not required to have, the UNC System SHIP.  If you are one of these students, you may purchase SHIP for the entire semester or for the portion of the semester when you are not in Study Abroad. Study Abroad students are not automatically enrolled or charged for the plan.  Study Abroad students MUST enroll themselves into the plan in order to participate in the plan.

Degree-seeking students participating in a Co-op program or as a student intern, are eligible for, but are not required to have the UNC System SHIP. Co-op students and Student Interns are not automatically enrolled or charged for the plan.  Co-op students and Student Interns MUST enroll themselves into the plan in order to participate in the plan.

NOTE: Students who are active military and/or dependents active military parents are note required to waive the University sponsored plan.

Steps to Completing Waiver/Enrollment

Pharmacy Guidelines

The SHS is staffed with a pharmacist during clinic hours. The Pharmacist or nurse will administer formulary medications to the students at no additional cost. The SHS Pharmacy will only dispense medications prescribed by the FHS assigned health provider. The Provider may write prescriptions for the students if the medication is not stocked in the SHS pharmacy. Prescriptions written by Providers not assigned to FSU must be taken to a local pharmacist. Pharmacy counselling is available and will automatically be provided with each prescription dispensed at the Student Health Pharmacy. Additional counseling is available on request.

Medical Excuses

Medical excuses are given only when the Medical Provider deems it medically necessary. An appointment with Student Health Services does not mandate a medical excuse. Medical excuses are not issued for missed class time. Therefore, students are strongly encouraged not to schedule appointments during class time.

Transportation

In emergency situations, the Emergency Medical System (911) will be activated for students who require it. The student will be responsible for charges or bills for EMS/ambulance services not covered by their medical insurance. Student Health Services is equipped to serve students in the Spaulding Building and cannot accommodate students in the residence halls or in classrooms. The Student Health Services' staff does not respond to medical calls outside of the facility. Students with OFF Campus appointments are responsible for arranging their own transportation and receiving a referral as needed from Student Health Services.Medical RecordsStudent medical records are available only to the professional staff of SHS and are considered confidential and privilege. Records may only be released with written permission by the student. Records are retained for eleven years after the student leaves the University and subsequently are destroyed.

Appointments

Appointments are required for all non-urgent medical conditions. Students who require immediate care for acute illnesses or injuries will be seen by a nurse who will assess and triage patients according to medical urgency.

Schedule an Appointment (In-person or Patient Portal):

Two Easy Ways:

• Call us at 910-672-1259
• Visit us in-person at the Student Health Center 

Medical Emergency

If you need care in the Fayetteville area when SHS is not open, please see the list of hospitals and urgent care centers below. Please note that SHS does not cover visits or charges incurred in the emergency room or urgent care; they are billed directly to your insurance. If your condition is not urgent or an emergency, please schedule an appointment with SHS during our business hours. 

Appointment Reminders

The day before your scheduled appointment at the SHC, you should receive an email reminder to your FSU University email account. This appointment reminder will include instructions regarding the completion of any pre-visit forms that may be required. A text message reminder will also be sent to students who have opted in to receiving text messages from the Student Health Center.

Late Arrival, Cancelled and Missed Appointments

If you arrive late, miss or fail to provide 1-hour cancellation notice for appointments at the SHC, an administrative fee up to $25 will be billed during your current appointment and will be paid at the end of visit.  

Same Day appointments 

Please schedule an appendment. Students who walk-in will be scheduled for the next available appointment which could be the same or following business day. Patients with urgent medical problems will be seen by a nurse who will make an assessment and triage the patient according to medical urgency. Wait times for this service will vary.

Checking-In for an Appointment

When you arrive for your appointment, you may use your mobile device or the self-check-in computers in the lobby or check-in at the Front Desk. Anyone without an appointment and is seeking medical care, must go to the Front Desk for further details.