Staff:

Debbie Quinn
Director

Cynthia Linton
Student Health
Administrator

Carisa Gipson
Student Health Assistant

Gianna Dimitrakos
Immunization Data Coordinator

John V. Pruitt, III, MD
Consulting Psychiatrist

Forms

Immunizations

• Immunization Form 2008
• Hepatitis B Antigen/Antibody Documentation Form
• Meningococcal Disease and Vaccine Information and Waiver for Students
• Meningococcal Immunization Form
• Rabies Vaccine Clinic

Insurance - Tufts Health Plan, HMO

• Tufts Health Plan (THP) Member Enrollment Form
• THP Enrollment Form Instructions
• Payroll Deduction Form for Sackler Students

Graduating & Cancelling Tufts Health Plan Insurance

• Tufts Health Plan Cancellation Policy and Form, 2008
• Dental Students Memo Re: Cancellation of THP, 2008
• Tufts Health Plan Sackler Students' Cancellation Policy and Form

Leaving the University & Cancelling Tufts Health Plan Insurance

• Leave of Absence - Keeping THP Health Insurance Agreement Form
• Leave of Absence - Cancelling THP Insurance Form
• Withdrawal/Dismissal - Cancelling THP Insurance Form

Health Insurance Waivers

• Regulations for Alternate Qualifying Insurance Coverage

Academic Year 2007-2008 - (current year - through 8/31/08)

• Waiver 2007-2008 - Dental, Medical, Nutrition, Veterinary Schools; and Public Health and Professional Degree Programs
• Waiver 2007-2008 - Sackler School, PHD and CR Programs

Academic Year 2008-2009 - (9/01/08 through 8/31/09)

• Waiver 2008-2009 - Dental, Medical, Nutrition, Veterinary Schools; and Public Health and Professional Degree Programs
• Waiver 2008-2009 - Sackler School: PHD and CR Programs

May 2008

Tufts University, Student Advisory & Health Administration,
200 Harrison Avenue, Boston, MA 02111
Phone: 617-636-2700, FAX: 617-636-2708

Copyright © 2001, Tufts University