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Universit de Rennes 2 Students Health Office (SIMPPS) Place du Recteur Henri le Moal
- Diphtheria, tetanus, poliomyelitis (diphtrie, ttanos, poliomylite). - Tuberculosis test (tuberculose BCG ou test). - Hepatitis B (hpatite B) In case of long-term treatment, please bring a recent prescription with your current treatment
notifying, if possible, the pharmacological names of your medicines (en cas de traitement de longue
dure : une ordonnance mdicale rcente rappelant vos traitements en cours, avec, si possible, le nom pharmacologique des mdicaments pris).
Have signed by your own doctor in your home country, within three months before arrival, a
Keep for yourself the original document during your stay in Rennes (garder loriginal avec vous
pendant votre sjour en France).
On arrival, give one copy to the Students Health Office (SIMPPS - Btiment EREVE Universit
Rennes).
Give another copy to the Residence Hall (remettre une copie votre Rsidence Universitaire).
Medical certificate
I, undersigned, .............................................. Address : ......................................................................................................................... General or specialist practitioner, hereby certify that : Mr or Miss : ........, date of birth : / / 19... Doesnt present any clinical sign of contagious disease (mainly tuberculosis) and can participate in social life. (Il ou elle ne prsente pas de signes cliniques de maladies contagieuses
-essentiellement tuberculeuse - et est apte la vie en collectivit).
Date of last tetanus booster dose (dernier rappel ttanique) : / / 19 Hepatitis B vaccine (Vaccin Hpatite B :1) / / 19 2) / / 19 3) / / 19 Vaccine against tuberculosis (non compulsory) (vaccin antituberculeux non obligatoire) : / / 19 Last tuberculine test (dernier test tuberculinique) : ... / ... / ... Result of the test (Rsultat du test) : ........................ Place (fait ) : ............................................. Date : ... / ... / 200.. Signature, professional status of the practitioner and official stamp (signature, statut et cachet du praticien) :
Universit de Rennes 2 Students Health Office (SIMPPS) Place du Recteur Henri le Moal
Give one copy to sport teacher - Rennes 2 University - Students Sports Office (donner une copy
de loriginal au professeur de sport -Universit de Rennes 2-Service des Sports Etudiants).
Medical certificate
I, undersigned, ....................................................... Address : ................................................................................................................................. General or specialist practitioner, hereby certify that : Mr or Miss : .........., date of birth : / / 19... Is physically able to participate and compete in sports activities (cet tudiant est physiquement apte pratiquer en comptition les sports). q Yes q No To notify absolutly the exact sport(s) she or he want to do (Nommer absolument les sports quil ou elle veut pratiquer) : Place (fait ) : ............................................. Date : ... / ... / 200.. Signature, professional status of the practitioner and official stamp (signature, statut et cachet du praticien) :