Congratulations, and welcome to the College from the staff of the Health and Wellness Center.

Enclosed are your Health Report /Immunization Form, Tuberculosis Risk Assessment Form (RAQ), Information/Waiver Form on Meningococcal Disease/Vaccine and return envelope. The deadline for submission is August 20, 2011 (Fall semester) or January 4, 2012 (Spring semester). Failure to complete these requirements, including all immunizations, by the first day of classes will result in a $50 late fee. Please complete pages 1 and 2 of the Health Report and the Tuberculosis Risk Assessment Form (RAQ) yourself. Make an appointment with your health care provider for a physical examination, review of your medical history and documentation of all required immunizations. Take the forms with you; pages 3 and 4 must be completed and signed by your primary care provider.

Documentation of the following immunizations is required by Massachusetts Law:

• Measles, Mumps, and Rubella (MMR) – Two doses required
• Hepatitis B – Three doses required
• Tetanus/Diphtheria- Booster within the last 10 years or, if >10 years, a booster of Tdap
• Meningococcal Vaccine OR signed Waiver for Meningococcal Vaccination Form, if you do not plan to live on campus. Your parent or guardian must sign this waiver form if you are under 18 years of age.
• Tuberculosis screening questionnaire (RAQ) - TB skin test and/or chest X-Ray must be performed, if indicated. 

We suggest that you obtain a copy of your immunization records from your school nurse. If you are unable to obtain your immunization records, you have the following options:

• Be re-immunized.
• Have a blood test to determine immunity to Measles, Mumps, Rubella, and Hepatitis B.
• If a blood test indicates that you are not immune, you must be re-immunized.

Proof of insurance is required by the state of Massachusetts. All Pine Manor students are automatically billed for the college’s student health insurance plan. You may waive this charge by documenting that you have comparable coverage under another plan. Foreign policies are not acceptable. For details of the College’s plan and to waive or enroll in the plan, go to: www.gallagherkoster.com For more information, please contact the Bursar at 617-731-7119.

We look forward to assisting you with your health care needs while you are at Pine Manor College. For more information about our services, the pre-entrance requirements for incoming students, and downloadable forms, please visit our website at www.pmc.edu.

Thank you for your cooperation.

Sincerely,
Barbara Inskeep, ANP-BC
Director of Health Services
inskeepbarbara@pmc.edu