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Medical Records

Medical Release Form

University Student Health Services (USHS) undertakes a legal and ethical responsibility to foster and preserve the privacy and confidentiality of patient information in all its stages of development and use. Accordingly, there shall be strict adherence to this basic principle: prior consent of the patient is required before information is released or disclosed or made available for review except where a specific law or regulation or the internal administrative needs of the clinic require or permit such access without patient consent.

The medical record is strictly confidential and must be protected against loss, tampering, alteration or inappropriate disclosure of information. No information may be released without the patient's consent unless requested by subpoena or as required by law.

The medical record is the property of USHS and shall be maintained to serve the patient, the health care provider, and the institution in accordance with legal, accrediting and regulatory agency requirements. All patient information shall be regarded as confidential and available only to authorized users.

Authorization for Release of Medical Records

Students requesting the release of medical records to or from Student Health may complete and sign the following Medical Release Form, which can be submitted to Student Health in-person, by mail, or by uploading through the Student Health Web Portal.

A properly completed and signed authorization is required for release of all confidential information except:

1. As required by law.
2. For release to another health care provider when a referral form has been completed and the information has been given to the patient.
3. For research and education in accordance with appropriate conditions.
4. Immunization records.
5. Tuberculosis skin testing results.

A properly completed and signed authorization shall include the following:

1. Name of party authorized to receive the information (company name, physician, friend, parent, insurance company, etc.).
2. Specific information to be released (general medical, GYN, mental health, letter, etc.).
3. Dates of treatment.
4. Date of birth or Student ID.
5. Signature of the patient.
6. Date signed.

Confidentiality Policy

USHS has a policy of strict confidentiality concerning medical records. USHS will not release patient information to anyone without the student's written, informed consent or a court order.

In addition to record contents, USHS staff protects personal demographic information and stores all medical records in a secure and locked location.

After patients graduate, USHS will keep their records for 10 years from the date of last service. In most cases, these medical records are held at a secure off-site professional storage facility.