Medical Student Immunization Record Form

Entering medical students are required to show:

  • Proof of immunity through blood titer to Measles (Rubeola), Mumps, German Measles (Rubella), and Hepatitis B.
  • Proof of immunity through blood titer or vaccination to Varicella.
  • Up-to-date Tetanus/Diphtheria/Pertussis vaccine.
  • Tuberculosis screening

This form must be returned to the Pritzker School of Medicine.

Medical Student Immunization Record Form (PDF)