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Health Care Proxy

The Health Care Proxy allows you to name someone to make decisions about your medical care—including decisions about life support—if you can no longer speak for yourself. This form is encouraged but not required.


Living Will

Living Will is a legal document that protects your right to refuse medical treatment you do not want or to request medical treatment you do want, in the event you lose the ability to make decisions for yourself.  This form is encouraged but not required.


Immunizations

MMR 

All registered students, regardless of number of credits taken, born during or after 1957 must provide proof of immunity against measles, mumps, and rubella or vaccination of 2 Measles, 1 Mumps, 1 Rubella.

Meningitis

Provide proof of vaccine given in last five years OR decline the vaccine through the patient portal.

Print Your Immunization Record


Student Athlete Forms

REQUIRED ATHLETE HEALTH FORMS MUST BE COMPLETED ONLINE in the Patient Portal by August 1. Paper forms are no longer available.

Returning Athletes

Complete Annual Update For Returning Athletes Form

  • Incomplete forms cannot be saved and submitted
  • Once form is completed, click Submit
  • Returning athletes do not need to provide Sickle Cell status or a physical

New Athletes

  1. New NCAA Athlete Health History
    • Answer all the questions in detail. Allow at least 20 minutes. Incomplete Forms Cannot Be Saved and Submitted.
    • Once form is completed, click Submit.
  2. Downloadable Forms: Physical Form
    • You must have a physical performed within the 12 months prior to the start of classes
    • Take this form to your doctor to be completed
    • Scan and upload this form back to the My Hazen site for our review
  3. Required Immunizations
    • Go to Immunization area and follow the instructions for Mandatory Immunizations

Once forms are processed, a secure email will be sent indicating missing requirements or clearance. Check to see if you have been cleared to participate in your sport: Log In >> Click “Immunization” tab >> “View History”

Last Updated 4/15/19

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