Middlebury Handbook

Center for Health and Wellness

The Center for Health and Wellness supports the learning environment of Middlebury’s vibrant and diverse academic community by providing readily accessible and confidential health care included in our comprehensive fee for students on our Vermont campuses. We utilize an inclusive, collaborative, and integrated treatment framework. Our multi-disciplinary staff are here to work with students and make referrals to community resources as needed.

We strive to create a safe, affirming, and nonjudgmental environment that embraces human diversity, including but not limited to race, color, ethnicity, national origin, religion, sex, sexual orientation, gender identity and expression, age, marital status, place of birth, and disability status. We are committed to respecting the uniqueness and complexity of student identities and life experiences.

This policy should not be interpreted as creating any contractual rights, and Middlebury College reserves the right to make changes to this policy at any time without prior notice.

a. Limits to Care for the Center for Health and Wellness and the State of Vermont

While we provide comprehensive care tailored for Middlebury students' needs, there are limits to the scope of our services and resources that students should be aware of. Some examples of health care needs that may be outside our scope include, but are not limited to:

• Specialized treatment not within the professional scope of our providers
• Situations where the recommended level of care is for an intensive outpatient program, partial hospitalization, inpatient, or residential programs, which are incompatible with Middlebury’s enrollment requirements.
• Students who are unable to safely possess and/or administer medications independently
• Recent or multiple hospitalizations
• Chronic thoughts of suicide or history of repeated suicide attempts
• Evidence or risk of progressive deterioration in mental or emotional functioning that requires intensive intervention
• Students who are unable to partner in their own healthcare, including utilizing established safety plans and/or engaging with recommended care within and outside of the Center
• Students who consistently need services more than once a week or after-hours, or whose situation cannot be stabilized with short-term crisis intervention.

Center for Health and Wellness staff can make referrals to specialists and intensive care options when indicated, but we cannot guarantee appointment availability, treatment, placement or admittance into any hospitals or programs, whether in Vermont or other locations.

Students coming to Middlebury with chronic conditions, interdisciplinary treatment teams, or known needs for frequent specialty services should have proactive conversations with their home-based providers to understand if there are any limits to their ability to provide continuous care. Center for Health and Wellness staff are available to coordinate and create plans for care transition or supplementation with home providers before arrival on campus including evaluations of whether care plans are in scope for the offices within the Center. Please contact the appropriate Center for Health and Wellness office or email chw@middlebury.edu to start the process as early as possible to avoid gaps in care.

b. Financial Responsibility and Opportunities for Assistance

Students who consent to off-campus referrals and/or the receipt of laboratory testing, imaging, prescriptions, or other kinds of care not covered by Middlebury’s comprehensive fee assume the financial responsibility or commit to negotiating satisfactory arrangements with the billing organization or provider. This includes contracted or consulting healthcare providers who may work under agreements with the Center for Health and Wellness to provide services to students on or off campus.

Center for Health and Wellness staff can help direct students to campus resources and community funding sources that may be able to assist with healthcare costs in addition to payment plan offerings for community providers who make them available to patients. Financial assistance from the Center for Health and Wellness is limited to students who qualify for the use of specific funds, including gifts and endowments, dedicated to substance use treatment and neurodiversity.

c. Insurance Coverage and Requirements

Middlebury College requires enrolled students to have sufficient health insurance coverage that meets the standards set by the state of Vermont. New students must attest to their coverage meeting institutional and state standards to waive the College-sponsored plan, or they must enroll in the College-sponsored plan. Questions about health insurance requirements, waivers, and status should be directed to Student Financial Services.

New students are required to upload copies of their health insurance card(s) as a part of the on-boarding process in their student health portal. While the Center for Health and Wellness does not bill for services, we can share the insurance information that is uploaded with outside providers at students’ request.

 Middlebury provides, as a part of the comprehensive fee, three insurance plans for Vermont-based students:

• All full-time students are enrolled in a $5,000, supplemental accident policy
• Participants in varsity and club sports have an additional layer of coverage provided by the College for athletic participation
• Participants in varsity sports have a third layer of participation coverage provided by the NCAA
• Students who seek healthcare due to an accident should contact Health Services (all students) or Sports Medicine (varsity athletes and eligible club sport athletes) for assistance in filing claims and seeking reimbursement related to supplemental accident policies. Students who sustain injuries while employed by Middlebury College are not eligible to receive healthcare at the Center for Health and Wellness and will be directed to community-based resources and any applicable College-sponsored insurance policies. None of the policies provided by the comprehensive fee serve as primary health insurance.

1. Pre-Matriculation Health Forms and Documents

a. Required Health Forms

The following forms and documents are required and must be completed and/or uploaded to the student health portal prior to arrival on campus for all new undergraduate students.

To be completed by each individual student in their student health portal:

1. Health History Form
2. Confidentiality and Consent to Treat Form
3. Emergency Contacts Form
4. Tuberculosis Screening Form

To be uploaded by each individual student to their student health portal:

1. Images of the front and back of insurance cards including primary, secondary, dental, and pharmacy plans
2. A copy of state-required immunization record(s)

b. Conditionally Required Health Forms

The following forms and documents are conditionally required, and must be completed and/or uploaded to the student health portal prior to arrival on campus for all new undergraduate students for whom they apply:

1. Provider Tuberculosis Status Form for students who are determined to be at risk for tuberculosis based on the Tuberculosis Screening form in the student health portal
2. Provisional Admittance Form for students who will not be in compliance with Vermont regulations for immunizations by their matriculation deadline and have a plan to meet the requirements within six (6) months of arrival on campus
3. All required forms for varsity and tier 1 club team athletic participation as outlined by Sports Medicine
4. Consent Form for Treatment of a Minor for students who will arrive on campus under the age of 18 (requires parent or guardian signature)
5. Documentation related to the following status(es) for students who will be minors at the time of matriculation (under 18 years old) and are able to consent to all healthcare independently in the State of Vermont because they are: married, have previously been married, are on active U.S. military duty, or have been emancipated by court order.

c. Due Dates

All pre-matriculation health forms and documents are due:

• July 1 for September matriculation
• November 15 for February matriculation

First-time student athletes and athletes returning from studying abroad must also ensure that they have completed all required conditions and forms, including a new physical within six months of the start of their season, to return to play.

All required forms and associated instructions for new students are available on the student health portal under “My Forms” and the Center for Health and Wellness’s Forms website.

2. Vaccines

a. Required Vaccines under Vermont Law

In order to remain enrolled as a residential undergraduate student, Vermont state law requires that all students submit an up-to-date immunization record, including proof of vaccination or positive titers (when applicable) for:

1. Diphtheria
2. Hepatitis B
3. Measles
4. Meningitis (ACWY)
5. Mumps
6. Pertussis
7. Rubella
8. Tetanus
9. Varicella

 b. Medical and Religious Exemptions

Students who have religious or medical exemptions for required vaccines must complete the Vermont College Immunizations Exemptions Form as applicable and upload the form in their student health portal as an Immunization Exemption.

Unvaccinated students (i.e., those with vaccination exemptions) may be asked to miss class or leave campus at their own expense in the event of cases of a communicable disease on campus or an outbreak, such as a measles outbreak. This includes students who have been provisionally admitted and are working toward compliance with Vermont State requirements.

Students who are provisionally admitted and are not in compliance with Vermont State requirements after six months from their arrival on campus will be referred to the Dean of Students to be placed on a mandatory leave of absence.  In order to return, students will be required to furnish immunization records in compliance with the requirements.

3. Health Records and Confidentiality

a. Understanding Your Health Record and Health Information

Each time students receive services or participate in programs with the Center for Health and Wellness offices (Counseling, Health Services, Health and Wellness Education, and Sports Medicine), our community or contracted care partners, or when staff have an interaction with another health care provider related to care, the information is documented in a confidential, secured, password protected electronic health record. Students’ electronic health records are accessible only to Center for Health and Wellness staff as necessary for health care operations and to each individual student via single sign-on credentials. Typically, these records contain a summary of presenting concerns and symptoms, physical exam and/or other intake information, test results, diagnoses, progress notes, treatment summaries, referrals to other resources, participation in an intervention or program, and plans for future courses of treatment if appropriate. This information makes up students’ health records or personal health information, and serves as a:

• Basis for planning care and treatment;
• Communication among health professionals providing care;
• Legal record of care received;
• Source of information for public health officials charged in the event of an outbreak, occurrence of communicable or infectious diseases or other public health emergency;
• Tool with which we can assess and continually work to improve the care we render and the outcomes we achieve.

Student health records at Middlebury may also contain information from other healthcare providers that students share with us or ask to be shared with us. Any physical records and all digital content are owned by Middlebury once in Middlebury’s possession. As patients, students are entitled to access their health records at all times through the student health portal and/or may request that we prepare a summary. Students may download, print, or save components or the entirety of their r health record at Middlebury through the student health portal at any time. Printed records or summaries can be requested by emailing chw@middlebury.edu. Center for Health and Wellness staff are available to review records with students by making an appointment during business hours.

b. Our Commitment to Confidentiality

Health records at the Center for Health and Wellness are confidential treatment records and are kept separate from all other educational records that may be created during enrollment. Center for Health and Wellness staff confer with one another as needed to provide integrated care. We also work with Porter Medical Center, the Counseling Service of Addison County (CSAC), and our telehealth partner TimelyCare to ensure a wide range of medical and mental healthcare options for students. Center for Health and Wellness staff are authorized to share personal health information with these important clinical community partners to ensure coordinated, high-quality, informed care for students including, but not limited to, urgent or emergent care situations.  When students receive treatment from multiple providers, in multiple locations, or with community providers, we exchange only such information as is needed to maintain continuity of care.

Students may authorize sharing of information to third parties such as family members, campus employees, and external health care facilities and they have the right to revoke that authorization at any time. The Center for Health and Wellness will not release any information about you to third parties outside of the healthcare partners named above without your authorization, except under the following conditions:

• As authorized or required by law (i.e., when we are presented with a valid court order requiring us to release records or when a student is diagnosed with or suspected of having a reportable disease, as required by the Department of Health);
• As necessary to protect the student or others from a serious, imminent threat to health and safety, or to protect against a serious, imminent threat of property damage;
• As necessary to notify parents, emergency contacts, and/or College officials when students have a serious mental or physical health problem and are unable or unwilling to assume responsibility for notifying others;
• Under some circumstances when legal guardians may have the right to access the records of a minor;
• As necessary in emergency situations

Middlebury College and the Center for Health and Wellness are regulated by the Family Education Rights Protection Act of 1974 (FERPA), which classifies your health records as confidential education records and incorporates privacy protections. Center for Health and Wellness staff operate under FERPA, State of Vermont statutes, institutional policies, and the ethics and guidelines of their individual licensure and/or certification status.  Middlebury College and the Center for Health and Wellness are not subject to the Health Insurance Portability and Accountability Act of 1996 (HIPAA) and therefore are not required to comply with those federal regulations relating to the use and disclosure of health information.

c. Treatment of Minors

Ordinarily, legal guardians must provide permission for some forms of healthcare for individuals under the age of 18 (minors), with certain exceptions. A legal guardian’s permission to receive healthcare is not required for:

• Emergency situations that necessitate immediate treatment;
• Outpatient mental health counseling, excluding prescription medications;
• Treatment for sexually transmitted infections, substance dependence, and/or substance abuse;
• Minors require hospitalization for treatment of sexually transmitted infections, substance dependence, or substance abuse. The legal guardian(s) must be notified of the hospitalization;
• Contraception, including medications, devices, and the termination of a pregnancy;
• Medical treatment related to rape, incest, or sexual abuse. Health care providers are required to report such incidents to the Department of Children and Families within 24 hours;
• Minors seeking treatment for any healthcare need who are married or have ever been married, minors on active U.S. military duty, and minors emancipated by court order may give informed consent to their own health care.

Center for Health and Wellness staff are available to provide an initial consultation with students who are under 18 years of age to review the need(s) for guardian consent for treatment(s) as stipulated by Vermont State law.

Additionally, minors arriving on campus will need to set up guardian-approved accounts to access telehealth through our partner TimelyCare. Students must call 1-833-484-5369 with a parent or guardian on the same line or on a conference call to create an account. Until the student turns 18, both the student and guardian(s) will be given access to the account to view upcoming appointments, treatment summaries, and any engagement with self-guided content in the application. Upon turning 18, students will be able to access TimelyCare with a private account through their Middlebury single sign-on credentials.

4. Questions and Grievance Process

Students with concerns, needs, or questions that were not (or could not be) addressed by staff members from the Center for Health and Wellness directly involved in care may contact the Associate Vice President for Student Health and Well-being at 802-443-5361 or chw@middlebury.edu, or the Vice President of Student Affairs at 802-443-2465 or vpsa@middlebury.edu.

Most professions in the Center for Health and Wellness are also governed by laws and/or professional organizations that define a scope of practice, professional conduct and/or codes of ethics. Healthcare consumers who have inquiries can contact those professional organizations directly or file a complaint with the State of Vermont via online form, phone (802-828-1505) or mail at the following address:

Secretary of State’s Office 89 Main Street, 3rd Floor Montpelier, VT 05620-3402

5. Emergencies

Unfortunately, health emergencies do occur for enrolled students at Middlebury. During emergencies, Center for Health and Wellness staff work to share important health information with students’ emergency contacts, campus officials and community healthcare partners to maximize safety and ensure continuity of care. After emergencies, Center staff partner with students to create and enact care plans to bridge them back to their residence and learning on campus or to trusted caregivers, healthcare facilities, or their community of origin.

a. Approval to Return to Residency after Health Emergencies or Hospitalizations

Students who experience health-related emergencies or hospitalizations while enrolled at Middlebury must be cleared to return to campus to ensure that they can safely and effectively participate in campus life. Ordinarily, this requires a safe discharge plan, where the level of support needed is consistent with campus resources. If harm to self or others was a concern related to admittance or seeking community-based services, a completed and appropriate safety plan is required without exception. In situations where a student is not approved to return to campus, students and their emergency contacts will be engaged to collaborate on an off-campus plan for care.

Because Middlebury requires students to live on-campus, clearance to return to residency is necessary to return to enrollment and class participation, with rare exceptions. A student not cleared to return to residency may be permitted by the Dean of Students (or designee) to return to classes for a short period, depending on the individual circumstances, while remaining in off-campus residency. Non-clearance may necessitate consideration of a Temporary Medical Leave, a Mandatory Leave of Absence, or may qualify as an emergency removal, subject to those policies.

Where a health-related emergency or hospitalization results in an Emergency Removal, Mandatory Leave of Absence, Temporary Medical Leave of Absence, or another change in student status, the applicable procedures, review processes, appeal rights, and return conditions described in the Emergency Removals Policy and Student Status Policy shall govern. This section is intended only to describe the clinical and support planning that may be required to facilitate a safe return to campus following a health-related emergency or hospitalization.

b. Required Personal Departure Plan in the Case of Evacuation or Emergency

Because of the potential need for a quick departure from campus related to a personal, family, or community emergency including response to an outbreak of communicable illness.

All students are required to submit their plan through Banner. Students should consider and plan for the following as a part of their personal departure plans:

• Any currently known reasons an emergency departure may be necessary (e.g., vaccination exemptions for communicable diseases, prior history of emergency departures, chronic health conditions, family needs, etc.)
• Primary and secondary safe locations to which a student could reasonably and safely return
• Travel plans for each identified location including mode of transportation (i.e., automobile, bus, train, plane, etc.)
• Cost considerations for the identified travel plans
• An identified person (who may or may not also be listed as an emergency contact in Banner) who could accompany you to travel if you are unable to safely do so on your own in an emergency, their phone number, physical/mailing address, and email address.

Students should alert any family members, friends, or trusted acquaintances that are a part of their emergency evacuation plan at the time of submission and annually thereafter. In situations where students may need to enact their departure plan or where plan review is required by College officials, persons identified in the plan may be contacted by the College to verify their participation in the plan. Students may not be allowed to attend classes, register for classes, or otherwise fully participate in their program until they have provided a plan that meets the minimum required elements as stated within each program.

6. Records Retention Policy

The Center for Health and Wellness engages in the following actions in order to appropriately maintain, retain, preserve and purge treatment records:

• The Center retains treatment records for the period of time required by applicable law and regulation as indicated in these guidelines;
• The Center purges treatment records promptly, in the appropriate manner after they have satisfied their required retention period, unless they are the subject of a Litigation Hold.

a. Retention Guidelines

Treatment records are to be retained, at minimum, for the time periods indicated as follows. The treatment records may be maintained in paper or electronic format, as appropriate, and may be stored on-site or off-site, in accordance with the need to access the records. The Center for Health and Wellness is responsible for records both created by staff and students and received from students and external healthcare providers.

Former students who have graduated from Middlebury or otherwise departed from the community who would like to request a copy of their records should email chw@middlebury.edu and include their name, date of birth, and Middlebury ID number. Records that are no longer in Middlebury’s possession due to the applicable record retention policy are no longer available to Center staff and cannot be furnished to former students.

Materials not subject to a retention requirement, and materials that are not considered “records” may be discarded once they no longer have administrative value.  Documents that are not considered “records” include: duplicate copies of correspondence or other documents, blank forms, and transitory messages used for informal communication of information only, such as voicemails, and self-sticking notes.