Health Forms

Welcome to Muhlenberg College!

The College requires all new incoming students (first-year and transfer) to complete essential health forms. Please complete the steps below by July 1 (for fall enrollment) or January 5 (for spring enrollment).

Step One: Read the following information

Information about Meningococcal Disease, Vaccination, and Waiver Form

The College and University Student Vaccination Act of 2002 in Pennsylvania prohibits a student from residing in college housing unless the student has received a one-time vaccination against meningococcal disease, or the institution provides detailed information on the risks associated with meningococcal disease and the availability and the effectiveness of any vaccine. The student must also sign a written waiver stating that the student has received and reviewed the information provided and has chosen not to be vaccinated for medical, religious, or philosophical reasons.

The Advisory Committee on Immunization Practices (ACIP) recommends that first-year college students living in residence halls should receive at least 1 dose of meningococcal conjugate vaccine (MCV4) before college entry. The preferred timing of the most recent dose is on or after their sixteenth birthday.

In accordance with the College and University Student Vaccination Act and ACIP, all students who will be living in college housing must submit proof of one dose of meningococcal conjugate vaccine that covers serogroups A, C, Y, and W since age sixteen. Students may request an exemption from this requirement if there is a medical contraindication to vaccination or if religious or philosophical beliefs prohibit immunization. The Meningococcal B vaccine (serogroup B) is a separate vaccine and is strongly recommended, although not mandatory at this time.

Prematriculation Immunization Policy

Policy for Exemption from Immunization

Request for Immunization Exemption Form

Step Two: Print and complete the Health Form

The health form contains the following information. Please make sure that all sections/forms are completed in their entirety.

• Medical History (pages 1-3)
• Verify that you created or updated your MyLVHN chart online (page 4)
• Complete the following LVHN Forms
  • Authorization for LVPG to Release Protected Health Information to Muhlenberg College (page 7)
  • Medical Information Communication Preference (page 8)
  • Consent for Treatment Form (pages 9-10). Student must be 18 years of age to sign this. If student is under 18 years, a parent or legal guardian must sign this form.
  • Medical Consent Authorization Minor (page 11). Must be completed by parent or legal guardian for student who is under 18 years of age
• Physical Exam (page 5)
• Immunization Record (page 6)

Step Three: Have your medical provider complete the Physical Exam and Immunization Record

• Both the Physical Exam Record and Immunization Record must be completed by your health care provider.
• The College requires that all students must have a physical exam within 12 months of the first day of class. The College requires that varsity athletes have a physical exam (within 6 months prior to the start of fall practice), EKG, and sickle cell screen.
• Before leaving your healthcare provider's office, ensure that all sections of the required record are completed, signed, and dated where indicated.
• Use the opportunity of visiting your healthcare provider to discuss any health conditions you may have and how you can be prepared to manage these conditions while you are at school.

Step Four: Submit your form

As a single file, upload Health Form, Physical Exam, Immunization Record, Authorization for LVPG to Release Protected Health Information, Consent for Treatment, Medical Consent Authorization for Minor (if student is < 18 years of age), Medical Information Communication Preference, copy of Insurance Card (front and back) here.

Students must enter their Muhlenberg email when uploading the health form.

Step Five: Create or Update your MyLVHN Chart online

To ensure a quick registration process, we encourage all students to have a “MyLVHN” chart. Please follow the steps below to update or create your MyLVHN chart.

For students under 18 years, please call the LVPG Family Medicine - Muhlenberg College (484-664-3199) to speak with our clerical staff to create your MyLVHN chart. Students cannot create a chart for themselves if they are under 18.

Login to MyLVHN

Students who already have a MyLVHN chart because they have accessed medical care previously by an LVHN provider do not need to create a new MyLVHN chart. If you have a MyChart account, login and proceed. If you do not have a MyChart account, create an account (Click “New user? Sign up now”)

Add your Health Insurance information

• Click on the three horizontal bars in upper left corner (“Your menu”)
• On the drop down menu, scroll down to “Insurance”
• Click “Insurance Summary”
• Click “Update Coverage”
• Click “Add Coverage” on bottom of screen
• Upload an image of your health insurance

Add your Personal Information

• Click on the three horizontal bars in upper left corner (“Your menu”)
• On the drop down menu, scroll down to “Account Settings”
• Click “Personal Information”
• Complete the following sections:
  • Personal Information
  • Contact Information
  • Details about me
  • Family and Friends to contact in case of emergency

Complete your Communication Preferences Form

• Click on the three horizontal bars in upper left corner (“Your menu”)
• In the search bar under “Your menu”, search for “Communication Preferences” and complete

Step Six: Student Health Insurance Plan – Enrollment or Waiver Required (Due August 1 for fall semester )

Login to waive or enroll in the student health insurance plan

**Special note for F-1 international students: Per visa requirements, F-1 students will continue to be automatically enrolled in the student health insurance plan. Students will expect to see the charge on their Fall billing statements. F-1 students WILL NOT need to enroll or waive this plan themselves since it will be automatic.