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700 College St.
Beloit, WI 53511
Porter Hall First Floor
608-363-2331
flotoj@beloit.edu
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HEALTH CENTER
Health Forms and Letters

Download Printer Friendly PDF Forms. Welcome to Beloit College !

This letter contains important information from the Health Center and the Athletic Trainer regarding your health care while attending Beloit College .

REQUIRED OF ALL STUDENTS

PLEASE READ ALL INFORMATION CAREFULLY.

* IMMUNIZATION REQUIREMENTS

PRIOR TO CLASS REGISTRATION AND ARRIVAL ON CAMPUS ALL STUDENTS MUST BE IN COMPLIANCE WITH THE STATE OF WISCONSIN AND THE COLLEGE. ALL entering college students born on or after January 1. 1957 MUST SHOW PROOF OF:

a. Having had 2 doses of MMR Vaccine (measles, mumps and rubella) or
b. Having had the diseases, measles, mumps and rubella or
c. Laboratory evidence of immunity

AND MUST Show proof of:

a. Having had the rubella vaccine on or after the first birthday; or
b. Laboratory evidence of Immunity

* THESE DATES MUST BE ENTERED ON THE PHYSICAL RECORD FORM BY THE PHYSICIAN OFFICE. (if you are unable to comply with the above, you must have the Immunizations repeated.)

* PHYSICAL EXAMINATION REQUIREMENT

Prior to arrival on campus and class registration, ALL STUDENTS MUST have a physical examination administered by a licensed physician of their choice on file with the Student Health Center .

A physical examination form is included with this letter along with insurance and emergency information. All information is confidential and a copy of the physical form will be sent to the head athletic trainer only if the student is planning to be on a varsity athletic roster. ALL REQUESTED INFORMATION MUST BE COMPLETED AND IN OUR OFFICE BEFORE THE STUDENT WILL BE ALLOWED TO ATTEND CLASSES OR PARTICIPATE IN VARSITY ATHLETICS. The form is due in the Health Center by July 15, for fall admission and January 1 for spring admission.

CAMPUS HEALTH CENTER

All students are encouraged to contact the Health Center for general health care. Beloit College has an agreement with area physicians to provide on campus coverage in the Health Center Monday through Friday.

Students seeking medical attention will have several options from which to choose. These options are:

• Consultation with the nurse (no charge)
• Scheduling an appointment with the campus physicians (these visits will be billed to the student's health insurance or to the student)
• Visiting an off-campus physician. The Health Center can assist students in setting up appointments. (These visits are billed to the student's health insurance or designated payer.)

Some of the physician services available on campus include:

• Gynecological Services/Birth Control
• STD Testing
• Physical Examinations
• Care of Illness
• Referral to specialists

We will continue to offer:

• Nurse assessment of health problems and Injuries
• Health Education resources and programs
• TB skin testing
• Nutrition counseling and information
• Wellness promotion
• Confidential Nurse counseling of health related concerns
• Travel Health
• Travel Health Counseling
• Vaccinations
• Gardasil Vaccine

SPORTSCENTER TRAINING ROOM

A full time, certified Athletic Trainer is available for all varsity athletes and to care for injuries sustained in and out of season. The athletic trainer cannot provide services to non-varsity athletes unless accompanied by a prescription from a licensed medical doctor. We have available for use (only by Dr.'s prescription) therapeutic whirlpools, hydrocollator packs, ice modalities, and various rehabilitation equipment. Due to staff and time limitations as well as legal ramifications we are unable to provide physical therapy for non-varsity students. With prescription for treatment from a physician, we can provide the student with basic treatments for mild injuries or ones that they would otherwise miss due to classes, time schedules or lack of transportation.

HEALTH INSURANCE

ALL BELOIT COLLEGE STUDENTS:

1. Student Medical Expenses are the responsibility of the student and/or parents. Please check your insurance policy as to the student's coverage while on campus if illness or injury should occur.

2. HMO policies may not cover the student. PLEASE check with your policy regarding HMO restrictions. We have experienced many problems in getting the needed care for students, especially those out of the insurance service area, and due to lack of coverage by HMO's (i.e. doctors' appointments, physical therapy, etc.). If this is a problem you may want to consider additional coverage for the student while on campus.

3. Additional Coverage: The College offers all students an insurance policy through the Dean of Students Office. You should receive this information in mid summer directly from Student Assurance Services. If you do not receive this information, please contact the Dean of Students office at (608) 363-2660.

4. Changes In Information: Insurance, emergency or medical information changes that need updating should be made available to the Health Center . The Health Center may be reached at (608) 363-2331. If the student is a varsity athlete, the Head Athletic Trainer must also be notified at (608) 363- 2233 or 365-2238.

5. MEDICAL, IMMUNIZATION AND INSURANCE INFORMATION MUST BE FILED PRIOR TO REGISTRATION OR THE STUDENT WILL NOT BE ALLOWED TO REGISTER FOR CLASSES. Please be advised, it is understood that any preexisting health condition not approved for coverage may not be covered by the College Health Plan. Beloit College will not assume responsibility for filing insurance claims or for medical expenses acquired by the student.

6. Please do not send insurance claim forms to the Health Center or Head Athletic Trainer. Forms should be in the possession of the student or bills acquired may be sent home for processing.

7. If your student will not be 18 by the time they arrive on campus, PLEASE make sure you sign the Permit to Treat as a parent or guardian giving us permission to treat your student while they are a student at Beloit College and are underage.

INTERNATIONAL STUDENTS

1. ALL international students are required to have the Beloit College Medical Insurance Coverage. If you have questions regarding health insurance while studying at Beloit College, please contact the Office of International Education at 608-363-2269 or Karen Skalak in the Accounting Department at 608-363-2239.

2. If you are planning to participate In varsity athletics and your plan does not cover injuries as a result of your participation, please call (608) 363-2238 for information.

VARSITY ATHLETES (If you are at all considering participating, please read)

If you are planning to compete in Intercollegiate Sports while attending Beloit College, you must be covered by insurance in accordance with new NCAA regulations. Please be aware that not all insurance policies automatically cover this participation. If you have been in contact with the Department of Athletics about participating then you will be receiving a letter from them outlining the details of the insurance requirements. If you have not been in contact with them, then please contact the Athletics Department to request the appropriate information at (608) 363-2238

ALL STUDENTS PLEASE READ
VERY IMPORTANT INFORMATION

In the fall of 2003 the State of Wisconsin passed legislation requiring all college students to be informed about the disease Meningococcal meningitis and hepatitis B. This legislation also requires all colleges to maintain certain records about the vaccination status of students.

We are now required to annually provide you detailed information on the risks associated with Meningococcal meningitis and hepatitis B, and the availability and effectiveness of the vaccines against the diseases. The college must also ensure that each student who resides in on-campus housing affirm that he or she has received this information. Also if they have been vaccinated against either disease, the date of the vaccination must be provided. Finally, we must maintain a confidential record of the affirmations and dates of the vaccines. If you are under the age of 18 this information must be provided to your parent or guardian. This information must be submitted along with your health form and on an annual basis while you are enrolled at the college.

Please read the enclosed information and sign the affirmation paper. Please return this form with your completed Beloit College Health form before your arrival on campus. Failure to return this information will result in a hold being placed on your registration. Thank you for your attention to this Wisconsin State Law. If you have questions please call the health center at 608-363-2331.

PLEASE NOTE:

Do not separate the white and yellow Pages of the health form. Mail them intact to the Health Center by July 15th.

If you have ANY questions, please feel free to contact us. We look forward to seeing you this fall on campus. Thank you for your cooperation.


Jan Floto, R.N., Health Center Director

Elliott Meyer, ATC, Head Athletic Trainer

Beloit College

Beloit College Athletics

700 College Street

700 College Street

Beloit , WI 53511

Beloit , WI 53511

(608) 363-2331

(608) 363-2233

PDF FORMS

Complete Letters and forms

CONFIDENTIAL STUDENT HEALTH HISTORY and PHYSICAL MEDICAL RECORD

MEDICAL HISTORY

PHYSICAL EXAMINATION

PERMISSION FOR TREATMENT

VACCINATION LETTER

Please read the PDF files below, prior to signing the "Vaccination Letter".

Hepatitis B fact sheet
Meningococcal fact sheet