Policies & Forms

I need more information about:

• Medical History and Immunization Records
• Submitting my Medical History and Immunization Records
• International Student Health Insurance
• Student Health Insurance 
• Release of Medical Information
• Voluntary Medical Leave of Absence
• Attention Deficit Hyperactivity Disorder (ADHD) FAQs

Medical History and Immunization Records

All full-time undergraduate students, including any student within Bright College, Law School, Occupational Therapy, Athletic Training, Nursing, and Pharmacy must complete and return a medical history form to the Student Health Center. Submitting this form before the start of the semester is incredibly important.

• Any student born after 1956 is required to provide documentation of receiving 2 measles, mumps, and rubella shots (2 MMR's), OR provide documentation of blood (lab) results for measles, mumps and rubella.
• Signatures of medical providers or photocopies of medical records are required.
• The TB questions on the health form MUST be answered. If you answer NO, nothing further is needed.
• The meningitis vaccine is highly suggested for new students living in the dorm setting. The state of Iowa requires a signature of waiver if you decline the vaccine.

Students who have not satisfied the above requirements will not be permitted to register for the following semester’s classes.

Download the Medical History Form (pdf) 

Submitting the Medical History Form

Please send the completed health form, immunization documents, and a copy of your insurance card directly to the Student Health Center located inside Broadlawns Community Clinic at Drake, prior to the start of the semester by mail or email.

Please send all records at the same time.

By Mail:
Broadlawns Community Clinic at Drake
2970 University Ave. Des Moines, IA 50311

By Fax: (515) 271-5199

By Email: drakecommunityclinic@broadlawns.org  

Religious Certificate of Immunization Exemption

In Iowa, a Certificate of Immunization Exemption can be requested for religious reasons, and the language used on this form is specifically outlined in Iowa Administrative Code, Chapter 7 641—7.3(139A). This language states that the immunization conflicts with a genuine and sincere religious belief, and that the belief is religious, not based on philosophical, scientific, moral, personal, or medical opposition to immunizations. If a certain immunization will be harmful to your health per the guidance of a licensed medical physician, please submit a letter from your licensed physician with your completed Medical History Form (pdf).

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Student Health Insurance

It’s recommended students have their insurance card on them and understand what their coverage entails.

Parents or students in need of health insurance should explore other options by visiting www.healthcare.gov. Parents can also elect to keep their child on their current plan if they prefer.
 

International Student Health Insurance

International students will automatically be enrolled into the Drake-offered Student Health Insurance Plan.

The monthly premium rate is $104.00 which will be charged the student’s account. The plan also allows international students to enroll a spouse and/or dependent(s). 

For more information about Drake International Student Health Insurance, contact the Division of Global Affairs department at 515-271-2084 or visit www.lewermarkinsurance /drake.
 

Release of Medical Information

For cases where the Broadlawns Community Clinic at Drake needs medical records, or if another medical facility should request medical records from the clinic the student will need to complete the “Authorization for Release of Medical Information” form.

This form specifies who’s releasing the information and where the student would like the information to be sent. All substance abuse, mental health, and HIV-related information need to be specifically authorized for release of information.

Voluntary Medical Leave of Absence

The “Voluntary Medical Leave of Absence” form is to be completed by students requesting a temporary leave from Drake University.

Upon completing the form, it may be provided to any one of the following:

• Associate Dean
• Drake University Counseling Center
• Broadlawns Community Clinic at Drake

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Attention Deficit Hyperactivity Disorder (ADHD) FAQs

I think I have ADHD but have not been diagnosed before.  Do you test/evaluate for ADHD?

We are not able to do testing for ADHD/ADD at student health.  If you have not previously been diagnosed, you will need to have an evaluation with a psychologist or licensed professional who has experience in testing and diagnosing ADHD/ADD.

I would like to transfer my treatment for ADD/ADHD to Student Health Services, what should I do? 

If you have been previously diagnosed with ADD/ADHD you will need to have your provider (Family physician, pediatrician, psychiatrist, Nurse Practitioner, or Physician Assistant) send records to the Student Health Center located inside Broadlawns Community Clinic at Drake. 

Records should include:

• Psychological testing records (if available)
• Last visit note/treatment note
• Medication dosages and last filled date

What happens when I am at home on break/summer?

Because many ADD/ADHD medications are controlled substances, we will not provide refills over breaks/summer semester unless you are able to have an in-patient follow up appointment.  If you reside out of state, you should plan on your normal provider to refill your medications.

I am being treated for ADHD, can I fill my prescriptions at school?

The person who is currently prescribing your medications can send prescriptions to the pharmacy of your choice.