Dean of Student Affairs Office
Tufts University
Dean of Student Affairs Office
Return from Hospitalization Worksheet
Contacts:
Resource / Student / Name / Tel / EmailDean of Student Affairs Resource / Undergrads
Grads and SMFA / 617-627-3158
Advising Dean / Undergrads and SMFA
Faculty Advisor / Grads
CMHS Clinician / Undergrads
Grads and SMFA
Health Service Clinical Director or Clinical Designee / Undergrads
Grads and SMFA
Students must receive approval from the Dean of Student Affairs Office before resuming residence and coursework following treatment for a health condition requiring emergency hospitalization. It is important for the student and their family to communicate with the appropriate dean about procedures regarding the continuation of studies after an emergency hospitalization.
A student cannot be discharged directly to Tufts University or return to campus unless the following process has been completed and received clearance from the Dean of Student Affairs Office.
Document Submission:Please submit the required documentation as soon as health care facility is able to provide the documents.
Document / Comments or guidelines / Submit to:☐ / Post-hospitalization discharge summary / Discharge summary from the admitting facility should be provided to the appropriate department. The summary should address:
- The student’s ability to interact with clinicians and willingness to engage in dialogue with the treating team
- The student’s use of treatment while in the hospital
- Recommendation of support systems that will enable the student to continue their education at Tuftsfollowing discharge from the hospital or treatment facility, if necessary - e.g., intensive outpatient care treatment, follow-up plan with outside providers
- Best assessments as to the student’s willingness to follow a treatment plan post-hospitalization - e.g. therapist, psychiatrist, nutritionist, medical provider, and frequency of contact
- Best assessment of the areas that may continue to be a challenge for the student. For example, risk of harm to self or others, substance use, or non-compliance with treatment
☐ / Release of Information / Request and sign a release of information form from each treatment provider and/or system of care you saw while hospitalized.
This form will authorize your provider to share the following information with the appropriate clinician at Tufts University Health Service (HS) or Counseling and Mental Health Services (CMHS).
The purpose gathering this information is to assist the Committee in determining whether the student is prepared to return to the rigors of postsecondary education, the student’s program of study, the residential community and what supports the student might require to achieve their goals at Tufts.
Information to be released may include:
- A clinical summary of the course of treatment while away from Tufts University
- authorize their off-campus treatment providers to speak with Tufts clinicians and vice versa
- If residential care or another system of care was involved (e.g. partial or day program), an original discharge summary from each system of care must also be submitted.
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Tufts University
Dean of Student Affairs Office
Return from Hospitalization Worksheet
If a medical related return, please FAX to:
Tufts University Health Service
124 Professors Row,
Medford, MA 02155
Fax: 617-627-3592
ATTN: Reentry Documentation
If a mental health related return, please FAX to:
Tufts University Counseling and Mental Health Service
120 Curtis Street
Medford, MA 02155
Fax: 617-627-3019
ATTN: Reentry Documentation
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Tufts University
Dean of Student Affairs Office
Return from Hospitalization Worksheet
Meetings: The appropriateDoSA resourcewill work with each student to coordinate necessary meetings based on individual circumstances. This may include resources listed below:
Resource / Name / Meeting DateDoSA Resource
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