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PURDUE UNIVERSITY CALUMET STUDENT HEALTH SERVICES CENTER IMMUNIZATION FORM NAME: D.O.B. (please print) Documentation of Immunity or Immunization TETANUS / DIPTHERIA/ PERTUSIS 1. a. Primary series.

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Log into One. IU and go to Med+Proctor Immunization to submit your information. If you need immunizations from IUPUI Campus Health, call 317-274-8214 to make an appointment.

You do not need to bring your physical insurance card, only your plan information. You will not be billed for the vaccination. If you are receiving your second dose or booster dose, you must also bring your CDC card showing proof of having received the first dose(s) of the Pfizer vaccine.

Students may upload their official immunization record OR a completed immunization information form signed by an MD, DO, NP, or RN. The official immunization record does not need to be signed by a provider. If you are not able to access the portal immediately, please check back during the first week of classes.

A. Login to your patient portal at myhealth.push.purdue.edu or on the PUSH website at purdue.edu/push. Once logged in, click the forms tab to locate the immunization information form.

Go to the Med+Proctor website or search for “Immunization Compliance” in One. IU to create an account and upload proof of compliance. Once you create a Med+Proctor account, you will have two options for submitting your documentation: Pay a one-time fee of $10 for lifetime access to any immunization records you upload.

Required Immunizations Two (2) doses of MMR (Measles, Mumps, and Rubella) received AFTER 1st birthday. TDAP or TD booster within the last ten (10) years. Meningococcal Conjugate (MCV4) on or after 16th birthday. Two (2) doses of Meningococcal B Series (if 25 years and younger)*

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Form Packages
Adoption
Bankruptcy
Contractors
Divorce
Home Sales
Employment
Identity Theft
Incorporation
Landlord Tenant
Living Trust
Name Change
Personal Planning
Small Business
Wills & Estates
Packages A-Z
Form Categories
Affidavits
Bankruptcy
Bill of Sale
Corporate - LLC
Divorce
Employment
Identity Theft
Internet Technology
Landlord Tenant
Living Wills
Name Change
Power of Attorney
Real Estate
Small Estates
Wills
All Forms
Forms A-Z
Form Library
Customer Service
Terms of Service
DMCA Policy
About Us
Blog
Affiliates
Contact Us
Privacy Notice
Delete My Account
Site Map
All Forms
Search all Forms
Industries
Forms in Spanish
Localized Forms
Legal Guides
Real Estate Handbook
All Guides
Prepared for You
Notarize
Incorporation services
Our Customers
For Consumers
For Small Business
For Attorneys
Our Sites
US Legal Forms
USLegal
FormsPass
pdfFiller
signNow
airSlate workflows
DocHub
Instapage
Social Media
Call us now toll free:
1-877-389-0141
As seen in:
  • USA Today logo picture
  • CBC News logo picture
  • LA Times logo picture
  • The Washington Post logo picture
  • AP logo picture
  • Forbes logo picture
© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232