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Health Clearance

& Insurance


Health Clearance Form

Once you have been officially accepted as an inbound exchange student to UHM, please remember to complete the Health Clearance Form. Please send the completed form to University Health Services as soon as you can (it is OK to submit the form after the deadline, but important to submit it before course registration begins). University Health Services Manoa does NOT accept this form by email - please mail or fax. Please do NOT email your form to MIX; it must be submitted directly to University Health Services.

The Health Clearance Form is five pages long, but you only need to submit two pages.  The first page contains useful information. The two pages that you need to return to University Health Services Manoa are pages 2 and 3. These are the “Health Clearance Form” and the “Immunization Record,” and are actually numbered “1 of 2” and “2 of 2."  

  • You may disregard part I ("Tuberculosis Control"). When you arrive to UHM, you will be required to report to University Health Services for a tuberculin (TB) skin test.
  • You must complete Part II ("MMR") and provide your MMR (measles, mumps, rubella) immunization record. You can either A) have your health care provider complete this page of the Health Clearance Form, B) submit a copy of your school or public health immunization record, or C) submit a copy of a health care provider's record.
  • The "Health Insurance" information on page 4 is primarily intended for U.S. citizens; unless you are a U.S. citizen, you do not need to complete the "Health Insurance Information Sheet" on page 5.

Health Insurance for International Students

International students must meet certain minimum health insurance coverage requirements. You will find more information about this at the UHSM website.  Use the link on the left for 'International Student Insurance.' There you will find the requirements (click link for “Insurance Requirements”) for both J-1 and F-1 students. NOTE: You are a J-1 student if you received a DS-2019 form; you are an F-1 student if you received an I-20 form.

Alternate Health Insurance: If you do not plan to purchase the UH Student Plan and are considering purchasing alternative health insurance, ISS acknowledges an alternative plan that meets both the J-1 federal and F-1 UH policy student health insurance standards.