Authorization To Use Or Disclose Health Information - Release Of Records printable pdf download

Authorization To Use Or Disclose Health Information - Release Of Records

Instructions for Authorization to Disclose Health Information

If you are a current student, then you can find your immunization records on Student

Link. Go to Student Link, then Personal, then Compliance Status, then Medical

Immunization Status, then Printable Version.

If you are not a current student or the previous directions did not work/provide the

information you were looking for, then please follow these directions:

To obtain your health record you will need to fill out an authorization to disclose health

information form (see next page). To submit: you can either walk the form in, mail it or

fax the form to us. We do not accept incoming medical information or requests via

email. Once we receive the form, we will need 2-3 business days to find your

information and send it off to where it needs to go. If you are requesting Behavioral

Health Records, please allow an additional 3 business days to process the request.

Limitations:

 We can only mail/fax this information within the United States of America. If you

need this information to go to an international location, then you will need to

select the Secure Email option for your release.

 Medical records are kept for 20 years and then are destroyed. We cannot fulfill

requests for records that are 20 years or older.

 Medical records prior to 2008 are not electronic and therefore cannot be sent via

secure email, therefore you will need to select a different method of delivery.

Our mailing address is:

Student Health Services

881 Commonwealth Ave

Boston, MA 02215

Our fax number is: 617-353-3557

Thank you,

Student Health Services

Authorization To Use Or Disclose Health Information - Release Of Records