Student Health Portal - Online Forms

Students need to complete the following applicable forms available via the Student Health Portal.

  1. Immunization History Form – Complete and submit this form using the Pre-entrance Immunization Form completed by your doctor, as mentioned in step 1 of this page's introduction. After you submit this form, use the “Document Upload” feature of the Health Portal to upload a copy of your completed Pre-entrance Immunization Form to the portal. (Details appear below.)
  2. Notice of Privacy Practices Form – Review and submit.
  3. Patient Information / Medical History Form – Complete and submit.
  4. Pre-entrance Tuberculosis Screening Form – Complete and submit.
  5. Local Contact Information Form - Complete and submit once you confirm your address for the fall 2022 semester.
  6. Health Insurance Waiver/Enrollment Form – Complete and submit no later than September 1. If you are waiving health insurance, use the “Document Upload” feature of the Health Portal to upload a copy of your insurance card. (More information about Student Health Insurance requirements)
  7. COVID-19 Testing Consent Form – Review and submit.
  8. Community Health and Safety Agreement – Review and submit once the agreement has been finalized and published for the fall 2022 semester.

  1. Create an account using your RPI email at https://rpi.studenthealthportal.com/
  2. Click on the "My Forms" section.
  3. Follow the directions to complete each form listed.

 

The Online Student Health Portal forms include a pre-entrance Tuberculosis Screening. For students who need to complete Tuberculosis testing in the United States, testing is available at the Student Health Center for a fee. The information below summarizes our Tuberculosis Screening Criteria found on the TB Screening Portal Form:

If you answer yes to any of the following criteria, you must submit results of a Mantoux (PPD) skin test OR Quantiferion Gold blood test to the RPI Student Health Center. Either test must have been conducted in the United States or Canada within the past 12 months.

  • Does this student have HIV?
  • Has this student been in close contact with anyone who has active TB?
  • Does the student have a persistent cough with night sweats, weight loss, fatigue or fever?
  • Has this student ever had a positive TB skin test?
  • Was this student born in or living in any countries that are NOT on the list below for more than one month?

NOTE: The countries listed below are WITHOUT endemic TB.

  • AMERICAN REGION:USA, Bermuda, British Virgin Islands, Canada, Cayman Islands, Chile, Costa Rica, Cuba, Jamaica, Saint Kitts and Nevis, Puerto Rico, Saint Lucia, Trinidad, Virgin Islands.
  • EUROPEAN REGION: Albania, Belgium, Cyprus, Denmark, Finland, France, Germany, Greece, Iceland, Ireland, Italy, Liechtenstein, Luxembourg, Malta, Monaco, Netherlands, Norway, San Marino, Slovakia, Slovenia, Sweden, Switzerland, United Kingdom.
  • WESTERN PACIFIC REGION: American Samoa, Australia, New Zealand.
  • MIDDLE EAST REGION: Israel, Jordan, Lebanon, UAE

If a student's PPD or Quantiferon results are positive, they must submit a copy of a chest x-ray (CXR) report. The test MUST have been done in the United States or Canada in the past 12 months.

The Health Center will provide Tuberculosis tests and immunizations for students who need them, and will schedule clinics for late August/early September. The Health Center will post details here and will also send email to students.

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