- Medical Withdrawal (Current or Prior Semester)
- Financial Assistance
- Authorization for the Treatment of Minors Form (PDF)
- General Consent to Treat Form (PDF)
- Immunization Documentation Form (PDF)
- Electronic Proof of Immunization Form
Medical Forms and Records
Confidentiality of SHS Treatment Records
The medical record of treatment received at the Student Health Service (SHS) 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 three 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.
Download Forms and Records
Forms in Chinese
Student Health Services
In an effort to support a healthy college experience, Student Health Services provides quality outpatient care, with services that include general medicine, injury care, and immunizations, as well as gynecology, laboratory, and psychiatry services.
Contact Us
Health Services Center
421 South Campus Avenue
Oxford, OH 45056
shsMiami@TriHealth.com
513-529-3000
513-529-1892 (fax)