Health Requirements for Rocky Vista University

DO and MSBS Programs

Congratulations on your acceptance! All acceptances are provisional contingent upon the successful completion of all requirements.

We know you are excited to embark on your medical education. Before you can get started, there are some important and mandatory
health requirements that MUST be completed before you will be allowed to start your classes. Rocky Vista University has contracted
with Sentry MD to store and maintain their student health forms. Sentry MD is a confidential student health record service.

It is critical that you begin this process as soon as possible after acceptance as some vaccine series can take 7 months if you need to
repeat them. Failure to have all requirements complete prior to the first day of orientation will result in the rescinding of your
admission.

STEP 1: Collect all requirements for immunizations, titers and health history detailed on the following pages (Part I to III).

STEP 2: If you can obtain most of the requirements and submit them as one pdf, that is encouraged.
However, because the vaccine series can take months if any of them need repeating, please upload results as they are
completed so we can see your progress. Submit all requirements to the Secure Student Uploader link at
[Link] or as a PDF attachment to RVU@[Link].

STEP 3: Login to your Sentry MD account to view your status and see your processed submissions (Login instructions on Part IV).
Please note logging in only allows you to see items that have been processed and processing can take 48 business hours after
your submission.

**You alone are responsible for maintaining compliance in all health requirements prior to and throughout your
participation in the program at RVU. You will receive monthly email reminder notices from Sentry MD regarding any
missing or expiring items and are expected to take necessary action. See instructions below for accessing your Sentry MD
account to manage your compliance and verify your status.**

Upload health records to Sentry MD through the Secure Student Uploader here: [Link]

If you have any questions regarding this packet, please email us at RVU@[Link].

If you have any questions regarding background check and drug screening, please email StudentCheck@[Link].
 Health Requirements for Rocky Vista University
DO and MSBS Programs

PART I | IMMUNIZATION AND TITER LAB REPORT REQUIREMENTS | Students must obtain copies of all requirements
listed below and submit them to Sentry MD to the Secure Student Uploader at [Link]

The following items are MANDATORY. Submit documentation of each item.

MANDATORY TITERS: A titer is a blood draw checking for antibodies to a disease. All titers must include
the QUANTITATIVE lab report, meaning results must be numerical with reference ranges, and show
immunity (positive antibody titer). Titers are mandatory regardless of previous vaccination. Qualitative
results will not be accepted.

Hepatitis B: A Surface Antibody (IgG) titer proving immunity (Quantitative lab report required)

MMR: An IgG titer proving immunity to Measles, Mumps, and Rubella (Quantitative lab report required)

Varicella: An IgG titer proving immunity (Quantitative lab report required)

**IMPORTANT**
o Students who submit a negative titer are required to receive the booster vaccine and then repeat the titer 4-6
weeks later. All items must be submitted to Sentry MD at
[Link]
o If you test as a non-converter or have an allergy to any of the diseases listed above, please submit
documentation from your provider to be reviewed by RVU administration.
______________________________________________________________________________________________
MANDATORY TESTING AND IMMUNIZATIONS: In addition to the mandatory titer reports, you must submit
documentation of the following:

Tuberculosis: Please submit one of the following options. Results must be dated between June 15-July 31st to
ensure that your TB is valid throughout the program year.
• TB Two Step: Two separate PPD skin tests within 21 days of each other and the most recent within 12
months of the current day, each with negative results OR
• A QuantiFERON or T-Spot blood test with a negative result
• If positive, a negative chest x-ray must be completed every 2 years.
**Annual Update Required. After initial Two-Step, only one skin test is required to update before the most recent
results expire. Blood tests and chest x-rays must be updated before the previous expires.**

Tdap: Must be dated within 10 years; Td booster within 10 years accepted ONLY with an original Tdap on file.

COVID-19 Vaccine(s) AND Booster: Submit documentation of each dose in original series AND booster dose if
2nd Moderna/Pfizer dose is dated more than 5 months from current date, or Janssen dose is dated more than 2 months
from current date.
______________________________________________________________________________________________
The following items are OPTIONAL. Submit documentation of each item if you receive them.

Influenza: Seasonal flu vaccine, typically August-May.

Student Name: DOB: Student ID #:

 Health Requirements for Rocky Vista University
DO and MSBS Programs

PART II- STUDENT HEALTH HISTORY | This must be completed by the student and signed, dated, AND stamped by a healthcare provider. In
the absence of a stamp, the provider’s business card may be submitted along with the form to support the documentation.
Last Name: First Name: DOB: _______ / _______ / _______

Student Health History

Student should complete the following:
☐ Previous Surgeries (Please specify):
☐ Serious Injuries/Fractures (Please specify):
☐ Drug Allergies (Include type of reaction):
☐ Family Health Issues (Father, Mother, Brothers, Sisters, Grandparents, Aunts, Uncles):
☐ Other Medical Problems or Hospital Admissions (Please specify):
Drug/Medication Yes/No Type Amount
Tobacco ☐ Yes ☐ No
Alcohol ☐ Yes ☐ No
“Street/Social” Drugs
☐ Yes ☐ No
Medications (prescribed
RX incl. birth control) ☐ Yes ☐ No
Herbal or Natural ☐ Yes ☐ No
Medications ☐ Yes ☐ No
OTC Medications
☐ Yes ☐ No
Personal/Family History
Indicate in the box to the left all that apply with “P” for personal or “F” for familial. Provide explanation on lines
below for all marked items.
☐ Asthma ☐ High Blood Pressure ☐ Thyroid Disease ☐ Inflammatory Bowel Disease
☐ Bronchitis ☐ Hepatitis ☐ Stroke ☐ Rectal Bleeding
☐ COPD ☐ Joint Pain or Swelling ☐ Hearing Impairment ☐ Visual Loss/Double Vision
☐ ADHD ☐ Blood Disorders ☐ Hiatal Hernia/Reflux ☐ Abnormal Heart Beats
☐ Dysmenorrhea ☐ STD ☐ Blood in Urine ☐ Problems with Fertility/Miscarriage
☐ Arthritis ☐ Liver Disease ☐ Angina ☐ Dizziness or Vertigo
☐ Diabetes ☐ Anemia ☐ Heart Attack ☐ Swelling or Edema
☐ Lower back pain ☐ Cancer/Tumor ☐ Hernia ☐ Alcohol or Drug Addiction
☐ Seizure/Tremor ☐ Migraines ☐ Kidney Problems ☐ Sudden loss of Strength or Sensations
☐ Ulcer Diseases ☐ Gout ☐ HIV Infection ☐ Psychiatric diagnosis or Treatment
☐ Fainting ☐ Loss of Limb ☐ Blood Clots ☐ Depression/Mood Disorder
☐ Psoriasis ☐ Head Injury ☐ Nicotine or Tobacco use/Dependency
Primary Care Provider Signature AND Provider’s stamp is required on this form to be accepted.

__________________________________ _______________
Provider’s Signature Date

Provider’s Name (printed): _______________________________

PLACE PROVIDER’S STAMP HERE
License # (required): ____________________________________
 Health Requirements for Rocky Vista University
DO and MSBS Programs

PART III | STUDENT AGREEMENT FORM | This must be completed by the student.

I hereby authorize Rocky Vista University and Sentry MD to release copies of my official student record, which may include any
or all of the following items for the purpose of clinical rotations.

DOCUMENTS/INFORMATION PERMITTED FOR RELEASE

Health records Demographic and Emergency Contact Information
Background check Bloodborne Pathogens Certifications
Drug Screening results HIPAA/OSHA certifications
Driver’s License Malpractice Insurance
Health Insurance COMLEX scores (if applicable)
CV/Resume/Biography Class Rank (if applicable)
Official Transcript USMLE score(s) (if applicable)
Digital Signature BLS/ACLS/PALS (if applicable)
EDUCATIONAL RECORDS MAY BE RELEASED TO:

Clinical Rotations Sites as assigned by Rocky Vista University

I give permission to Rocky Vista University and Sentry MD to:

• Obtain all medical information necessary to complete this history and physical examination form.
• Release my medical information for the purpose of fulfilling clinical requirements.
• I have reviewed this immunization history for completeness and agree to release the information provided on the Rocky Vista
University Immunization Transcript to authorized members of the Rocky Vista University staff and staff of cooperating agencies, as
may be required.

______________________________________ ________________
Student Signature Date of Birth

______________________________________ _________________
Student Name (Print) Date
 Health Requirements for Rocky Vista University
DO and MSBS Programs

Student Checklist

Quantitative lab reports for all mandatory titers (HepB, MMR, Varicella) (Part I)
Documentation of all mandatory testing and immunizations (Part I)
Student Health History has been completed, signed, dated, AND stamped by your Health
Care Provider (Part II)
Sign and submit Student Consent Statement to Sentry MD (Part III)
Submit your completed forms by uploading them as a PDF to the Secure Student Uploader at
[Link]

All of the above documents are to be submitted to Sentry MD by the first day of orientation. Do NOT depend on your
physician’s office to be on top of this; you alone are responsible to see that the correct tests/ titers have been drawn and
that the results have been submitted to Sentry MD.
You alone are responsible for maintaining compliance in all health requirements throughout your participation in
the program at RVU. You will receive monthly email reminder notices from Sentry MD regarding any missing or
expiring items and are expected to take necessary action. See instructions below for accessing your Sentry MD
account to manage your compliance and verify your status.

Please email any questions you may have to RVU@[Link]

PART IV- ACCOUNT ACCESS:

Please note your account will only be available after you have registered and sent Part I of this packet into Sentry MD. Your account
allows you to see your status and download/print documents that have been processed by Sentry MD. Please make sure to submit
document requirements to the Upload link [Link] as you are not able to upload directly to
your account, all documents are reviewed and processed prior to showing in your account (Processing can take 24 to 48 hours).

Link to Sentry MD system:

[Link]
1. Enter your User ID: (email address in all lowercase)
2. Click on ‘Create or Reset Password’
3. Enter your email address (your User ID will be the email address you registered with in all lowercase)
4. You will be sent a token to your email address
5. Enter Token from email onto site
6. Create a Password
7. Click link to go to login screen.
Once you are logged into your account, you will note on the landing page how easy it is to see if you are compliant or not with the
requirements for your program. A blue checkmark next to each of the requirements means you are compliant. Requirements without
the blue checkmark indicate you are missing documentation these items need your attention.

In addition to viewing your status at any time, you can download and print your landing page checklist and any or all the documents
you have submitted by clicking the Documents Button. Only documents that have completed processing will appear in your account,
please note processing can take 48 business hours. We hope these tools help you stay on top of your status and keep you compliant
with your program requirements.