Private Provider Health Clearance Instructions

1. Fill out the Confidential Health History Form, and the top portion and vaccine compliance section of the health clearance

2.Complete the required Health and Safety Course, linked in your UCEAP Portal.

3.Review the Health chapter of the Guide to Study Abroad linked in your UCEAP Portal.

4.Research medication legality if you will be traveling with prescription medication.

If you’re completing the UCEAP health clearance through Kaiser, your Kaiser doctor might not fill out the UCEAP Health Clearance form unless you attend an in-person appointment, and even during an in-person appointment, your Kaiser doctor still might not sign it. If your Kaiser doctor will not sign the UCEAP form, you must request a Pre-Participation Physical form. This is a Kaiser form UCEAP is authorized to accept.

Schedule an appointment with your doctor, specialists (if applicable), and a travel health clinic if recommended by your doctor. See your specialist(s) before you see your general practitioner. This appointment is to discuss medication and treatment plans during your program abroad, and to obtain your providers’ signatures indicating you are cleared to participate. We cannot waive this requirement. All information is confidential and may only be shared with UCEAP officials in an emergency. Failure to provide complete and accurate information may be grounds for non-participation in UCEAP.

Confidential Health History Form

Complete the Confidential Health History Form clearly and accurately before each appointment, and sign it. You must provide the completed form to each doctor and specialist who will sign your clearance. Disclosing physical and mental conditions is essential so the doctor can discuss a treatment plan for your time abroad. 

UCEAP Health Clearance Form

Complete the top of the UCEAP Health Clearance Form with your name and complete program information (Country, Host Univ, Program Name, and Term). 

Program-specific Form

Bring any program-specific forms with you as applicable. Please refer to the first drop-down menu of your country-specific page and/or the UCEAP Predeparture Requirements to determine if you have any required forms.

Please share these instructions with your healthcare provider.

1. Review the student’s Confidential Health History Form and/or health history on file. Students may have additional forms required by host university/country.

2. Consider student’s stability of medical conditions, compliance, and treatment plan if needed.

3. Discuss medication or treatment availability in the host country.

4. Consider environmental or programmatic factors that may affect chronic conditions.

5. If student is seeing a specialist, the general practitioner should review any specialist notes.

6. Sign the form under the appropriate box (general practitioner or specialist).

Attend the appointment with completed documents in hand, including any specialist clearances already received. Ask the physician to carefully follow the instructions on the front page of the UCEAP Health Clearance Form & Instructions for Private Health Care Providers.

Submit Completed Health Clearance form by either eFax or email by the stipulated deadline in your UCEAP Portal.

1. Email a copy to healthclearance@uceap.universityofcalifornia.edu

or

2. E-fax a copy to 805-893-3021

Note: Using non-encrypted email to send your completed health clearance is not private or secure. Also, there is a possibility that the email could be intercepted and read by others whom you did not intend to receive it.

*Barbados participants must submit their completed West indies Confidential Medical Questionnaire to the campus International Office

Take your Confidential Health History form with you abroad for personal reference—do not submit this form to UCEAP.

If  there  are  any  changes  to  your  health  after  submitting the  health  clearance  form,  you  must  notify  UCEAP.  You  may  be required to submit an updated health clearance or treating doctor’s letter.