Yale University Health Services

Each new student is required to supply Yale University Health Services (YUHS) with a complete health history, proof of a recent physical examination, and a complete immunization record. All forms must be completed and submitted by mail on or before July 20, 2009. (Applicants accepted from the Waiting List may submit this material after July 20 if necessary. Call the Admissions Office for guidance.) You will not be permitted to register as a new student on August 25 unless all the forms have been submitted and the immunization requirements have been met.

Please print the forms that apply to you and submit by mail to the following address:

YUHS Office of Health Promotion
17 Hillhouse Ave.
P.O. Box 208237
New Haven, CT 06520-8237

FIRST: Read and Review the following:

□ Notice of Privacy Practices (NOPP)

□ Quick Guide to Yale University Health Services for an overview of services provided and Yale Health Plan (YHP) coverage.

□ YHP Student Handbook, for detailed plan information and decide whether to keep Yale Health Plan Hospitalization/Specialty Care Coverage or waive the coverage - proof of alternate hospitalization coverage is required. Students enrolled at least half-time in a Yale degree program are automatically enrolled and charged a premium for YHP Hospitalization/Specialty Care and YHP Prescription Plus. Students will be contacted via email with instructions for submitting an insurance waiver online at https://yhpstudentwaiver.yale.edu/ starting in June.

SECOND: Complete and return the forms that apply to you:

□ REQUIRED: Acknowledgement of Receipt form – (due July 20, 2009) required by HIPAA legislation.

□ REQUIRED: Health Form and Physical Exam – (due July 20, 2009) required by Yale University.

□ REQUIRED: Health Professions Vaccination Record – (due July 20, 2009) required by the State of Connecticut.

□ OPTIONAL: Student Allergy Medical Treatment Plan – (Only for students who have begun allergy immunotherapy and want to continue to receive allergy injections while on campus.)

□ OPTIONAL: Waiver submission – (Only for those students who want to waive part of the coverage. Available beginning in June; deadline September 15, 2009)

Contact our Member Services Department at member.services@yale.edu (203-432-0246) if you have any questions or to discuss your options for health coverage.

We’re working together to get you off to a healthy start at Yale!

For more information about Yale University Health Services, please visit their website.