Medical Forms and Records

Download Forms and Records

Medical Withdrawal (Current or Prior Semester)

Authorization for the Treatment of Minors Form (PDF, opens in a new window)

Health Services Medical Form (PDF, opens in a new window)

Vaccination Requirement Form (PDF, opens in a new window)

Vaccination Exemption Form (PDF, opens in a new window)

Instructions for web portal registration:

Before students can access web portal they must first register with a user name and password. Once registered, the web portal will e-mail a confirmation password to the email address listed during registration. This will allow access to the web portal. Here you can complete and submit your mandatory three-part medical history form. Be prepared to provide immunization records of your last two MMR (measles, mumps, and rubella) immunizations. Proof of these are required by the university.

Confidentiality

The medical record of treatment received at the Student Health Service is considered confidential information and will only be released under specific conditions.

Students may initiate release of their medical information with the SHS staff. The release MUST be in writing; forms are available at the SHS. If students are away from campus, a signed authorization from the student patient is still necessary. Authorizations must include Name, Banner Identification Number, date last attended/or graduated from Miami, where the information should be sent, the student's signature and date. Authorizations dated more than 3 months prior to receipt will not be accepted. Faxed requests are acceptable at 513-529-1892.

In addition, Student Health Service staff may not discuss the patient’s records with others, including family members, without proper authorization from the student.

Student Health Records are retained in the Medical Records Department for a total of seven years (in addition to current year from date of last entry), after which time the records will be destroyed.