Forms

Patient Forms

PATIENT COMPLAINT

CONSENT TO TREAT A MINOR

RELEASE OF INFORMATION

RELEASE OF INFORMATION MENTAL HEALTH RECORDS

ABSENCE NOTIFICATION FOR STUDENTS

IMMUNIZATION EXEMPTION REQUEST

Patient Rights & Policies

A medical record is maintained on every person who receives care at Student Health Services. All information in the record is confidential.

Access to information contained in your file is limited to you (the patient) and Student Health Services personnel, unless you give written permission to disclose it, except by court order. All employees sign a confidentiality pledge.

PATIENT BILL OF RIGHTS AND RESPONSIBILITIES

NOTICE OF PRIVACY PRACTICES - FERPA (STUDENT)

NOTICE OF PRIVACY PRACTICES - HIPAA (NON-STUDENT)