Forms and Medical Records
All medical records are strictly confidential. Information from records will not be released to any one without the written authorization of the patient, except as required by law. The staff at the Student Health Center can assist you with the following services:
- Requesting copies of your medical records
Sending copies of your medical records to an outside provider
Clearing Immunization holds
Confidentiality
Information maintained in the student’s medical record are confidential, and access is restricted to authorized CSU Student Health Center personnel ONLY. We will not notify parents, professors or anyone regarding your health care, except in a life-threatening situation or if you are a minor. Your confidential medical records are not available to anyone unless you provide written consent or when required by law by public health laws, by court order or when subpoenaed.
Form | Release of Medical Records (PDF) To release your Student Health Records to another facility or provider. We can not mail or fax records to students directly. You must show proof of identity in order to pick up records in person. We do not copy the entire chart; please indicate specific date(s) needed. Please allow 7-10 working days to process.
Form | Request for Medical Records (PDF)If you need your records from somewhere else mailed or faxed to us.
Form | Consent for Medical Treatment of a Minor (PDF)
If you are under 18 years of age, we must have your parents *consent to provide care for you.
*(Exception- Califonia Law: Request for contraception services, or an Emancipated Minor)
Form | Immunization Exemption Declaration (PDF) A Signed Waiver, that you are exempt from Immunization due to personal, medical or religious beliefs. Must bring into Health Center for verification. Please Note: students understand this waiver may bar students from campus in an outbreak situation for their own protection or that of campus community.
