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Health Clearance

& Health Insurance

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Health Clearance Form

Once you have been officially accepted as an inbound exchange/visiting student, you must submit the Health Clearance Form. The form must be sent directly to University Health Services by postal mail, fax, or UH File Drop. The form is NOT accepted by email. Please do NOT email your form to MIX; it must be submitted directly to University Health Services.

Instructions for Completing the Form:

The Health Clearance Form document is a total of five pages, however you only need to fill out and submit the second and third pages of it. These are the second and third pages, labeled Health Clearance Form - 1 of 2 and Immunization Record - 2 of 2.  

  • First Page: Contains detailed information about immunization records and tuberculosis testing. Please read it carefully.
  • Second Page: Labeled Health Clearance Form - 1 of 2. You must return this part of the form. Please fill it out as completely as possible.
  • Third Page: Labeled Immunization Record - 2 of 2.
    • You may disregard Part I ("Tuberculosis Control"). Hawai'i State law requires that the tuberculin (TB) skin test be performed by a U.S.-licensed physician. Because it can be quite difficult to locate a U.S.-licensed physician outside of the U.S., the vast majority of exchange/visiting students complete this part of the Health Clearance process when they first arrive in Hawai'i and report to the University Health Services clinic for a tuberculin (TB) skin test. The test takes a minimum of 48-72 hours to complete and the cost for the test is $12 USD (subject to change). University Health Services provides the test every weekday except Thursday. Check their website for opening hours and further details.
    • 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 Part, B) submit a copy of your school or public health immunization record, or C) submit a copy of a health care provider's record. (This part of the form does not need to be completed by a U.S.-licensed physician.)
  • Fourth and Fifth Pages: 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.

NOTE: Exchange/visiting students may submit the form after the deadline stated on the form, but must submit it before the first day of classes or may risk being automatically disenrolled from classes.

NOTE 2: Exchange/visiting students who intend to live in on-campus housing must obtain a complete Health Clearance (MMR immunization AND TB clearance) before you will be allowed to move in to your housing.

Questions? Refer to the FAQ on Health Clearance. If you don't see your question answered there, you can email inbound@hawaii.edu for further guidance.


Health Insurance Clearance for International Students

Both J-1 and F-1 visa holders must provide proof of health insurance in the U.S. that meets certain minimum coverage requirements in order to receive health insurance clearance.

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.

  • J-1 students - The International Student Services Office (ISS) must review your insurance coverage to verify that it meets minimum coverage requirements required by U.S. immigration law. For an overview of health insurance in the U.S. and to see the four options that you have for receiving health insurance clearance, please read the J-1 Health Insurance FAQ Sheet. At your Visa Clearance Session, you must submit proof of health insurance to ISS to receive health insurance clearance. Questions? Contact ISS at issmanoa@hawaii.edu.

  • F-1 students - The Student Health Insurance Office (SHIO) must review your insurance coverage. For an overview of health insurance in the U.S. and to see the three options that you have for receiving health insurance clearance, please read the F-1 Health Insurance FAQ Sheet. Upon arrival to UHM, you must submit proof of health insurance to SHIO in Queen Liliuo'kalani Center (QLC) for Student Services Room 313-D to receive your health insurance clearance. Questions? Contact SHIO at shio@hawaii.edu.