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- Orrico Hall Upper Level, MSC 147
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Health Center: Health Center: Forms
If you are interested in learning more about our policies, or if you need to access one of our forms, you may download them here and print them directly from your computer. The forms we currently have available are listed below; if you do not see a form you need to complete, please contact the Health Center.
Release of Confidential Information
Students who wish to have the University Health Center (UHC) communicate with third parties about their health care, counseling or disability services must complete this authorization form. For example, if the student wishes the UHC staff to communicate with prior or current professional care providers, parents, or particular faculty in order to coordinate care or support processes, this authorization form would need to be signed for each entity to receive or exchange the privileged communications. By law and professional ethics, such signed authorizations are not required in the event of emergencies involving an imminent threat of harm. In such cases, the UHC staff can notify third parties of information necessary to attempt to prevent harm from occurring.
Click here to access the online Health History form! All students at the University are required to submit a Health History form and provide, according to State Law, documentation of having received two doses of the measles or MMR vaccine. Tip: To expedite the completion of the form, please have your immunization record(s) on hand.
Confidentiality Statement and Consent to Treatment
Communication between you and University Health Center Staff are confidential as required (and except as limited) by law. Generally, information may not be disclosed to another person or agency outside of the University Health Center (including parents, teachers or Residence Life staff) without your written consent.
Health Insurance Information (Provided by Aetna Student Health)
All full-time undergraduate students are required to carry medical insurance and are automatically enrolled in the Aetna Student Health Insurance plan.Students with comparable existing health insurance coverage may opt to waive the health insurance. For students entering in the fall semester, the waiver form is available in mid-July. For instructions on how to waive the Aetna Student Health Insurance, please click here to be directed to the Student Accounts webpage.
If you would like more information about the Aetna Student Health Insurance plan, please review the 2012-2013 Aetna Student Health Insurance Brochure for a brief overview of coverage. Additional information, brochures, and claim information are available from the Aetna Student Health website - www.aetnastudenthealth.com - or by calling 1-877-373-2756.
International students are required to have a tuberculosis skin test (PPD) performed by a United States health care provider no later than two (2) weeks into the semester.