Get University Student Health Services - Division Of Student Affairs ... - Students Vcu

Filling out the University Student Health Services authorization form is an essential step for users seeking to obtain medical records or information. This guide offers clear, step-by-step instructions to assist in completing the form accurately and efficiently.

Follow the steps to complete the authorization for release of medical records.

1. Press the ‘Get Form’ button to access the authorization form and open it in your preferred document editor.
2. Begin by entering your full name in the designated field at the top of the form, followed by your social security number and date of birth. This information helps identify your medical records.
3. Fill out your current address, which should include your street address, city, state, and zip code. Ensure this information is accurate to avoid any delays.
4. In the section titled 'I hereby authorize the release of medical information:', indicate the recipient of your medical information. Fill in 'To/ VCU Student Health Services' and provide the address listed on the form.
5. Complete the 'From:' section by filling in your own name and address as the sender of the medical records.
6. Specify the type of information needed by checking the appropriate boxes for annual gyn exam, lab results, medical notes, x-ray report, complete record, immunization records, or any other relevant information.
7. If applicable, provide a purpose for the disclosure of your medical records by checking the relevant option such as continuing medical treatment, insurance, consultation, or attorney.
8. Review the statements regarding your rights to inspect or obtain copies of your records, and certify your understanding by signing and dating the form where indicated.
9. If you are consenting to the release of sensitive records (alcohol, drug, infectious disease, mental health), ensure to sign and date the designated section.
10. Finally, note the preferred method of information delivery (faxed, mailed, or picked-up) in the section reserved for Student Health Services use and finalize the form by ensuring all sections are complete.
11. After completing the form, you can save changes, download, print, or share the completed authorization as necessary.

Complete your authorization form online today and take a step towards securing your medical records.