Columbia University Health Services

Documentation of Immunity to Measles, Mumps, and Rubella (MMR)
New York State public health law requires that college and university students taking six or more points provide documentation of immunity to measles, mumps and rubella (MMR) before their first term of study. There are several ways to document immunity. The options are described on the Columbia University MMR Form. Completed forms must be submitted to the Immunization Compliance Office on the ground floor of Wien Hall no later than August 31, 2009.

Ways to Document Immunity
Measles: 2 doses of live measles virus vaccine, the first dose administered no more than 4 days prior to first birthday and the second dose administered more than 28 days after the first dose and after 15 months of age. Measles vaccine doses administered prior to 1968 are not valid unless documentation specifically states it was a LIVE vaccine.

Mumps: 1 injection required. Vaccine was not available in the U.S. until 1/1/69, therefore no statement of immunization administered before that date is acceptable.

Rubella: 1 injection required. Vaccine was not available in the U.S. until 1/1/69, therefore no statement of immunization administered before that date is acceptable.

Please note: The MMR combined vaccination fulfills the requirement for 1 measles, 1 mumps, and 1 rubella immunization; a second measles shot is required. MMR was not available in the United States before 1/1/72; therefore, no immunizations administered before that date are acceptable for US students.

Documented History of Illness
If diagnosed by a physician, a history of having had measles and/or mumps is acceptable proof of immunity. The physician or provider must enter the dates of initial diagnosis on the Columbia University MMR Form. A diagnosis of previous rubella disease is not acceptable proof of immunity under the New York State Health Code.

Immunity Proven by Serologic Testing
Immunity to all the three diseases may be proven by a single blood test for antibodies. You must submit a copy of the actual laboratory report with this form.

Exemptions
Medical Exemption from the Immunization Requirements: A letter from your physician giving the specific diagnosis and/or treatment which you believe precludes further immunizations must be submitted. The final decision to grant an exemption lies with Health Services at Columbia.

Religious Exemption from Immunization Requirements: Most religious groups which object to immunizations will provide you with a standard form indicating such objection. Alternatively you may submit a letter explaining the religious basis of your objection. The final decision to grant an exemption lies with Health Services at Columbia.

Columbia University MMR Form
Students: Complete the top portion of this form. Once your physician or health care provider has completed the form, make a copy for your records and return the original to the Immunization Compliance Office . Forms may also be faxed to 212 854 5078. Be aware that this form is not valid without your University Identification Number (UNI) and birth date and will not be processed without a health care provider’s signature, stamp, and license number.

Physicians or other Health Care Provider: Complete all parts of Section A or Section B. For each section, please put a check beside the relevant documentation being provided and provide the date of immunization, illness and/or serologic testing, in the corresponding box to the right. Please note the date format of Month/Day/Year (MM/ DD/YY). All immunizations must have been received after the first birthday. Laboratory results must be provided if proving immunity by serologic testing. This form will not be processed without a health care provider’s signature, stamp, and license number.