Medical Records & Forms

Required Immunizations

Bucknell requires students to have the following immunizations. Additional information about vaccinations and dates of administration can be found in the medical record form.

Forms and Instructions

Who should complete these forms?

• All full-time undergraduate students must submit medical information to Bucknell Student Health by June 15 in order to receive their room key during Move-in.
• Summer Session students must also complete these forms and submit them by May 1.
• Students returning from a Leave of Absence or who have been readmitted to Bucknell must bring their medical record up to date. Each student’s record will need to be reviewed on a case-by-case basis. Please reach out to student health once you have claimed your Bucknell email address and completed your requirements through your academic dean.

You must complete and submit the following information:

• Demographic information and consent to treat
• Student Health medical provider packet — print this form and have your medical provider complete the following sections.
  • Immunization sheet, completed on our form with printed record attached
  • Physical record, completed on our form, completed within one year of the first day of classes (six months for varsity athletes)
  • Tuberculin skin test/QuantiFERON gold test
  • Submit medical provider packet
• Insurance form — you will need a pdf copy of the front and back of your insurance card

After your medical packet has been reviewed, you may be asked to provide additional information or documentation. Use the miscellaneous document upload form to send that information.

What if I am missing one of the above?

That's OK. Submit completed forms as soon as they are available. You do not need to wait until all forms have been completed.

Learn more about medical records and hear from Bucknell's insurance liaison in our Virtual Summer Information Sessions series

Additional Forms for Varsity Athletes

In addition to completing the appropriate Bucknell Medical Record form, varsity athletes must submit additional medical forms to the NCCA to qualify for athletics participation.

As soon as you receive your ARMS software account from the Bucknell Compliance Office, please check it to access all forms assigned to you (my.armssoftware.com/arms).

• Pre-participation physical and sickle cell test results
• First-year medical history questionnaire
• ADHD form (required for those who are prescribed ADHD medication)
• Concussion education acknowledgement and baseline testing form
• Medical insurance and injury responsibility form
• Emergency contact and general information form
• Sports medicine signature forms

Completed medical forms for NCAA Athletics Participation must be submitted through the ARMS software account. Substitute forms will not be accepted for athletics participation. Forms will be checked by a member of the athletics training staff and will be approved or rejected. If rejected, the student will be notified with a message sent to their @bucknell.edu email address regarding the reason so it can be rectified. Even if a form is approved, a staff member may be in touch with more follow-up questions if needed.

Additional documentation/medical records might be requested depending on some of the answers you provided. The initial due date for sports medicine forms is June 15. If you have any questions while completing the form, please email sports-medicine@bucknell.edu.

Release of Medical Records

Bucknell Student Health is required by government regulations to receive written permission from a student before sharing any medical information with other health providers (for reasons other than continuation of care). This written permission is also needed for any disclosure of information to a student’s parent/guardian. In order for Bucknell Student Health to release your medical information, you must provide a written request.

Please be aware that any information release that is not sent directly to another physician/medical facility for continuation of care cannot be faxed or emailed. It must be sent through regular mail or picked up by the patient. Authorization forms for release of information may be obtained below or at Bucknell Student Health.

Requests for records should be submitted to medicalrecords@bucknell.edu. Please complete the Geisinger release form below and include it in your email.

Geisinger Medical Information Release Authorization