Medical Forms

Required Medical Forms For All New Incoming Students

Holy Cross Health Services requires all new incoming students to submit the Holy Cross Medical Record Forms. Forms should be completed and uploaded by August 15th. Please note the following instructions: 

Immunization History

The form should be printed and completed by your healthcare provider. All students are required to enter their immunization dates and upload forms into the Patient Portal. You may refer to the following YouYube video to assist you in uploading documents and entering your immunizations in the patient portal (https://youtu.be/OeZ5929Oy8w). The Health Services staff will verify that the immunization data correlates with the data that was submitted online.  For more information, please see Massachusetts regulations regarding immunizations.

• Immunization History Form  (PDF)
• Medical/Religious Exemption Form (PDF)
• COVID-19 Medical/ Religious Exemption Form (PDF)

Students requesting an exemption for an immunization must complete the exemption form. They must be aware that if an outbreak of vaccine-preventable disease should occur, an exempt student will be excluded from class and/or the residence halls for a period of time.

Physical Examination Form

The form should be printed and completed by your healthcare provider and uploaded into the Patient Portal.

• Physical Form (PDF)

Massachusetts Tuberculosis Risk Assessment

This form is located on the patient portal. Click on the form tab under the to do list. Click on Tb risk assessment form. Complete form and click submit. If you answer yes to any of the questions you should contact your healthcare provider. A tuberculin skin test or IGRA may be indicated.

• MA TB Risk Assessment User Guide

Meningitis Vaccine Information and Waiver

Meningitis vaccine booster at > age sixteen. If you wish to waive the vaccine you will need to print, complete and upload the form into the Patient Portal.

• Meningitis Vaccine Waiver (PDF)

Insurance Information/ Insurance Cards

• Submitted via University Health Plans.    
• Upload a photocopy of the front and back of your medical/prescription insurance cards for our records.  Have your student carry his/her insurance cards on them when they come to college.

Minors

If you will not be 18 years old by August 30, 2020, please print and have your parent/guardian complete the Authorization to Treat a Minor Form. 

• Authorization to Treat a Minor Form (PDF)

How to Upload Required Forms

When the above forms are completed they may be uploaded via the Holy Cross Patient Portal. You must complete both steps of the upload process. 

1. Under "Immunizations" enter dates of all immunizations received
2. Under "Upload" please upload required forms using the drop-down list 

 

 

First Year Division 1 Varsity Student-Athletes

Required Sports Medicine forms for all incoming and first-year varsity student-athletes must be completed prior to any athletic participation

Due: July 15 or 1 week prior to your arrival - whichever comes earliest

Incoming Student-Athlete Checklist

• Pre-Participation Physical Evaluation History Form
• Orthopedic Health History Form
• Insurance Policy & Policy Holder Information Form - Please be sure to provide a copy of the student-athlete's insurance card
• Medical Consent and Shared Responsibility Form - Electronic form located within your Patiet Portal
  • NOTE: If you will be under the age of 18 at the start of your athletic season, please use the link to download the form to allow parent/guardian consent and upload to Patient Portal with other forms
• Holy Cross Sports-Related Concussion Policy - Please read the document and return only applicable forms
• Online ImPACT Concussion Baseline Test Instructions - Please be sure to document your Passport ID that is generated upon completion of the ImPACT test on your SCR Responsibility Statement 
• Student-Athlete Authorization and Disclosure of Medical Information Form
• NCAA ADHD Drug Exception Policy Form - Please submit appropriate supporting documentation if applicable
• Sickle Cell Trait Explanation and Consent Form - The NCAA has mandated that all incoming Division 1 student-athletes submit proof of having been tested for Sickle Cell Trait.  You must mail a copy of the current lab results or the lab results dating from birth to the Sports Medicine Department.  Lab results must be in to the Sports Medicine Department prior to participation in any intercollegiate activity.
• COVID-19 History/Immunization Questionnaire - Electronic form located within your Patient Portal

Upload Forms to Student-Athlete's Patient Portal  - Patient Portal 

Any questions can be directed to the Sports Medicine Department at (508) 793-2627