Medical Student Requirements

Your first interaction with Health Services will be the health requirements that you must meet as an incoming medical student. This will begin our partnership in caring for your health while you are at Brown. Please be sure to take a few minutes to explore Health Services and Counseling & Psychological Services websites for information about our services and health promotion.

The deadline for submission is June 1, 2019.

Please review and complete the required information listed. All forms can be accessed from the links below. For continuity of care, we request that students forward their medical records for any chronic, serious medical condition.

 To return forms, the student must login at Brown Health Services Patient Portal and upload the forms.

If you are unable to upload, fax the forms to 401-863-7953 or mail to:
Brown University
Health Services
Box 1928
Providence, RI 02912

If you have any questions about your medical forms, please refer to Frequently Asked Questions before contacting us.

Steps 1, 2, 3, 4 and 5 are required for all students.

Step 1: Medical Student Immunization Record, Titers  & TB Screening Record (required)
Brown University requires all medical students to provide written documentation of the following on the Medical Student Immunization, Titers & Tuberculosis Screening Record. 

Vaccine Requirements: 

Hepatitis B
A record of Hepatitis B vaccine, three doses. If series complete, a quantitative Hepatitis B Surface Antibody titer must be done with a copy of the lab report attached. 

Measles, Mumps and Rubella
A record of two MMR vaccines and positive serological tests for immunity to Measles, Mumps and Rubella. History of disease is not acceptable. A copy of the lab reports must be attached.

Meningococcal
A record of Meningococcal vaccine if under 22 years old. If first dose was given before the age of 16 years, a booster dose must be recorded.

Tetanus/Diphtheria/Pertussis
One dose of adult Tdap (Tetanus/Diphtheria/Pertussis). If last Tdap dose is more than 10 years old, then a Tetanus Diptheria booster is also required. 

Varicella
Positive serological test for immunity to Varicella (chickenpox) only if a history of chickenpox disease. History of disease alone is not acceptable. A copy of the lab report must be attached OR a record of Varicella vaccine, two doses, at least one month apart.

Influenza
Please note that the Influenza vaccine will be required during the Fall 2019. 

Tuberculosis Screening 

A record of two tuberculosis skin test (TST) – two tests 1-3 weeks apart OR one IGRA blood test (Quantiferon/T-Spot), completed within 6 months of arrival at Brown.  If there is a positive result to either test, documentation of a negative chest x-ray and history of latent TB treatment must be attached. 

Any additional immunizations should be documented on page 2 of the form. 

Submission Requirements: 

  • If you attended Brown in the past, login to the Brown Health Services Patient Portal and click on immunization history to verify that you have receieved all required vaccines and titers. If not, please obtain the missing vaccine(s) and titer and upload the documentation. 
  • Print the Medical Student Immunization, Titers & TB Screening Record and forward it to your medical provider for completion
  • When you receive the completed form and titer results, log into Brown Health Services Patient Portal
  • Select Immunization, then Enter Dates
  • Enter the vaccine and titer dates/results as documented on your Immunization, Titers and TB Screening Record. You do not need to enter any of your TB Screening information.
  • then select Upload
  • from the pull down menu, select Medical School Requirements
  • attach a copy of your Immunization, Titers and TB Screening Record along with your titer results and upload

We will also accept official immunization records from your provider, previous school or health department, but please be sure to fulfill all requirement as documented on the Brown form.

Step 2: Health History Form (required)
The information on this form provides our staff with an overview of your health status and past medical history, allows us to provide you with the best care possible and to meet your health care needs. All medical information is strictly confidential, and cannot be released to anyone (including your parents, professors) without your authorization.

This form must be completed by the student only. It does not need to be completed nor reviewed by your medical provider.

Step 3: Authorization for Medical Care and Treatment Form (required)

Step 4: Respiratory Medical Evaluation Form (required)
This form must be completed prior to N95 Mask Fitting which will occur during orientation.

Step 5: Medical Insurance Card and Prescription Benefits Card
(required for all students that do not have the Brown sponsored insurance plan)

  • log into Brown Health Services Patient Portal
  • select Upload
  • from the pull down menu, select Medical Insurance Card or Prescription Benefit Card, if applicable
  • upload of copy of both sides of your card(s)

If your insurance changes in the future, please upload a copy of your new card or bring the card to Health Services so we can update your information.