SHC

How to Submit COVID-19 Vaccine Self-Certification Via Patient Portal

To comply with the CSU COVID-19 Vaccine Self-Certification requirement, please follow the directions. Your submission will be reviewed and processed within 5 business days.

Submit your COVID-19 Vaccine Self-Certification ***REQUIREMENT***

PDF of these instructions

  1. Be prepared! Please follow the step-by-step instructions you’ll need to complete your requirements online.
  2. Please log into the MyHealth Patient Portal.
  3. Enter your CSUN Username and Password.
    Submit your COVID-19 Vaccine Attestation ***REQUIREMENT*** Step 3
  4. Select the drop down arrows. Enter month, day, and year of birth.
    Submit your COVID-19 Vaccine Attestation ***REQUIREMENT*** Step 4
  5. The Home screen will display CSUN COVID-19 Requirement. Select COVID-19 Vaccine Attestation:
    Submit your COVID-19 Vaccine Attestation ***REQUIREMENT*** Step 5
  6. Select Update to complete the COVID-19 Vaccine Attestation.
    Submit your COVID-19 Vaccine Attestation ***REQUIREMENT*** Step 6
  7. Enter your:
    • CSUN ID number
    • Last name
    • First name, and
    • CSUN Email address
    Submit your COVID-19 Vaccine Attestation ***REQUIREMENT*** Step 7
  8. Review Section I: Self-Certification of COVID-19 Vaccine Status and select the appropriate statement.
    Submit your COVID-19 Vaccine Attestation ***REQUIREMENT*** Step 8
  9. Review Section II: Accuracy of Information Provided and select the attestation to accuracy of information provided statements.
    Submit your COVID-19 Vaccine Attestation ***REQUIREMENT*** Step 9
  10. Select Submit Final to submit the final content of the form, or Cancel to start over.
    Submit your COVID-19 Vaccine Attestation ***REQUIREMENT*** Step 10
  11. Once completed, the message "The COVID-19 Vaccine Attestation has been successfully submitted" displays on the screen, confirming your COVID-19 Vaccine Attestation submission.
    Submit your COVID-19 Vaccine Attestation ***REQUIREMENT*** Step 11
  12. Select "Proceed" (as shown in the image above). The COVID-19 Vaccine Attestation will display its status as "Compliant".
    Submit your COVID-19 Vaccine Attestation ***REQUIREMENT*** Step 12
  13. If you are requesting a Medical or Religious Exemption, you must complete the "Submit at COVID-19 Vaccine Exemption Request." Please complete next steps below.


Based on your self-certification, please complete the appropriate steps.

Submit a COVID-19 Vaccine Exemption Request

To submit a COVID-19 Vaccine Exemption Request please follow the instructions:

PDF of these instructions

Select COVID-19 Vaccine Exemption Requests on the home screen.

COVID-19 Vaccine Requirement

To Submit a Religious Exemption Instructions:

  1. Select Download in the COVID-19 Vaccine Declaration of Religious Exemption section.
    COVID-19 Vaccine Religious Exemption Step 1
  2. Save the PDF and complete the form.
  3. Upload the completed form by selecting Upload in the COVID-19 Vaccine Declaration of Religious Exemption section.
    COVID-19 Vaccine Religious Exemption Step 1
    Note: Your request will be acknowledged and reviewed within 5 business days.

To Submit a Medical Exemption Instructions:

  1. Select Download in the COVID-19 Vaccine Medical Exemption Request section.
    COVID-19 Medical Exemption Step 1
  2. Save the PDF. Complete the Student section of the form and send to your certified or licensed healthcare professional for completion.
  3. Upload the completed form by selecting Upload in the COVID-19 Vaccine Medical Exemption Request section.
    COVID-19 Medical Exemption Step 3
    Note: Your request will be acknowledged and reviewed within 5 business days.

Submit your COVID-19 Vaccine Record

PDF of these instructions

  1. The Home screen will display CSUN COVID-19 Requirement. Select COVID-19 Vaccine Record Upload:
    Submit your COVID-19 Vaccine Record Step 1
  2. Select Update to complete the COVID-19 Vaccine Record.
    Submit your COVID-19 Vaccine Record Step 2
  3. Select Upload to add your COVID-19 Vaccination record.
    Submit your COVID-19 Vaccine Record Step 3
  4. Complete dose(s) of COVID-19 vaccine information including:
    1. Vaccination date(s)
    2. Vaccine name/manufacturer by selecting option from drop down
    Submit your COVID-19 Vaccine Record Step 4
  5. Select Done to submit the final content of the form or Cancel to start over.
    Submit your COVID-19 Vaccine Record Step 5
  6. When finished, select Log Out.
    Submit your COVID-19 Vaccine Record Step 6

View your COVID-19 Vaccine Self-Certification Status

To view your COVID-19 vaccine attestation status:

PDF of these instructions

  1. Select Medical Clearances on the navigation menu.
    COVID-19 Vaccine Requirement Status Step 1
  2. If the status of the "COVID-19 Vaccination Attestation" reads "Compliant," you have successfully submitted your COVID-19 Vaccine Attestation. If additional information is needed, you will be contacted by a representative.
    COVID-19 Vaccine Requirement Status Step 2

Access Secure Messages from the Klotz Student Health Center

To access your secure messages, please complete the SHC Notice of Privacy Practices form.

PDF of these instructions

  1. Login to myHealth Patient Portal. Enter Username and Password.
  2. Select the drop-down arrows. Enter month, day, and year of birth.
  3. Select Messages.
    Step 3
  4. Select Medical Clearances
    Step 4
  5. Select SHC Notice of Privacy Practices
    Step 5
  6. Select the box that you have read and acknowledged receipt of the document, "HIPAA Privacy Notice"
    Step 6
  7. When finished, select Log-out.

If you need assistance, please call the Klotz SHC at 818-677-3666, Option 1.

To request a copy of your completed SHC Notice of Privacy Practices form, please contact the Klotz SHC at 818-677-3666, Option 1.