Clinical Health Care Services

Any student requesting services must complete the required documentation  prior to scheduling an appointment regardless of credit hours or status. All new students, transfer students, returning former FSU students, students taking more than four hours on campus before 5:00p.m., and students applying for admission to the Teacher Education Program must complete all medical and immunization requirements.*

Immunization Record & Medical History Form

Fillable Medical History Form 

Meningococcal Vaccination Waiver & Information Sheet

Release of Information from FSU

Release of Information to FSU

Medical Exemption Statement Form

North Carolina State law (General Statue 130 A 152-157), requires that all students present documented proof of specific immunizations. The required immunizations are listed on the medical history/immunizations form required of all students prior to registration. Immunization Record & Medical History Forms are available at the Student Health Services located in the Spaulding building or here. All medical information is confidential and is not divulged without the written consent of the student or parent/legal guardian of a minor student.

North Carolina State law (General Statue 130 A 152-157), requires that all students present documented proof of specific immunizations. The required immunizations are listed on the medical history/immunizations form required of all students prior to registration. Immunization Record & Medical History Forms are available at the Student Health Services located in the Spaulding building or here. All medical information is confidential and is not divulged without the written consent of the student or parent/legal guardian of a minor student.

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 evening (starting at 5:00 pm, c) student taking weekend classes only, and d) students taking off campus classes for the duration of their degree program.PLEASE NOTE: Any student requesting services must submit a completed Immunization Record & Medical History Form prior to receiving services regardless of credit hours or status.The minimum immunization requirements are:

1. Three (3) doses of tetanus/diphtheria toxoid - Diphtheria, Tetanus, and/or Pertussis -(DTP, DTaP, TD, Tdap) - One must have been within the past 10 years
2. Polio (oral): Proof of 3 doses required if under age 18.
3. One (1) Meningococcal or wavier
4. Hepatitis B: Required if born on or after July 1, 1994.
5. Two (2) MMR - Measles, Mumps, Rubella vaccine: Two doses required if born after December 31, 1956.
   • Lab report to show proof of immunity to Measles, Mumps, and Rubella (MMR) by blood test (titer) will satisfy the Measles, Mumps, and Rubella (MMR) requirement.
   • Rubella (German Measles): Required if under age 50.
   • Vaccine (after 6-9-96) or proof of immunity by blood test (titer).

SPECIAL EMPHASIS

1. Month, date, and year are required for each immunization.
2. Handwritten records must be verified by either a physician's signature or by a clinic/ health department stamp.
3. Any request for medical exemption from the immunization requirement must be verified by a physician. The physician must complete the Medical Exemption Statement Form (DHHS form 3987). The form must be submitted to Student Health Services.

The University is required by law to withdraw any student who does not provide the appropriate immunization records. This administrative withdrawal can result in loss of grades and/or credit for your courses.

Fayetteville State University requires each student to have accident and sickness insurance protection either by their personal policy or under the Student Insurance Plan (Student Blue).

More information regarding the Student Insurance Plan (Student Blue) is available at Student Health Services or can be found online at bcbsnc.com/student.

The premium for the Student Insurance Plan (Student Blue) is included in each student's semester bill. Students who do NOT wish to be enrolled in the Student Insurance Plan MUST complete the insurance waiver form online ONLY.

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.