Health Evaluation form contains the following:

• Medical Practitioner's Report of Health Evaluation -Physical Examination to be performed by your own health care provider.
• Student Report of Medical History - to be completed by student.
• Immunization record - To include all vaccines and immunizations.
• Medical Practitioner's Disclosure - Verification of immunizations and required Tuberculosis testing within 12 months of MU Admission, signed by Health Care Provider.

Copies of medical records require written permission before they can be released to your family doctor, specialists, etc. Download and fax to Health Services if you request your records be sent to another provider.

Follow the steps below:

1. Click on the desired form
2. Print it out
3. Fill out the information
4. Return it to the Health center using the following address or fax:
   

   Health Services
   Millersville University
   P.O. Box 1002
   Millersville, PA 17551-0302
   Fax: (717) 871-2243

Personal Medical Records are not to be transmitted electronically to Health Services. Please mail or fax any personal medical information to maintain confidentiality.

It is a REQUIREMENT for each incoming student to have a completed Health Evaluation Form on file in the Health Services.