Mandatory Medical Requirements

All incoming students are required to complete the Medical History and Physical Form.

Print the two page medical history/physical form located at the bottom of this page. The student must complete page one, which is the medical history portion of the form. Schedule a physical examination with your medical provider. Your provider will review your completed medical history form, conduct a physical and complete the physical exam section of the form located on page two.

The completed medical history/physical form must be returned to the campus health nurse along with the following attachments:

• A photocopy of the front and back of your primary major medical insurance card. For specific insurance requirements for athletes and non-athletes click HERE.
   
• A photocopy of the documentation of your two MMR (Measles, Mumps and Rubella) vaccines. This may be found on your immunization record(s), i.e. childhood shot record. Also include Hepatitis B, Meningitis and Varicella (chickenpox) vaccination dates if done. For specific information on immunizations click HERE.
   
• Proof of Hepatitis B Vaccine - recommended for all students, mandatory for nursing and athletic training majors.
   
• Incoming students must also document proof of a TB (Tuberculosis) skin test done within the past year. If the student has had a positive TB skin test in the past, a copy of the most recent chest x-ray must be submitted with the physical.

Send this information to the following address.

Donna Gerlach, RN
1200 West University Ave., Box 906
Mitchell, SD 57301
Phone (605)-995-2950
E-mail: dogerlac@dwu.edu

Please notify Donna Gerlach if you need a hard copy of the
medical history/physical form sent to you via the mail.