Health Service Records and Forms

Medical Records

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 - on a per incident basis - 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.

 
 
 
 
 Quick Facts
 - Medical records will only be released with a signed authorization from the student patient.
  PRIVACY PRACTICES
  STUDENT COMMENT FORM
  PATIENT BILL OF RIGHTS
  PATIENT CONDUCT AND RESPONSIBILITIES
 

MEDICAL FORMS:
INTERNATIONAL GRADUATE STUDENTS

GRADUATE STUDENTS

INTERNATIONAL UNDERGRADUATE STUDENTS

REQUEST FOR MEDICAL WITHDRAWAL

BANNER FORM FOR DEPARTMENT CHARGE

PARENTAL CONSENT FORM (ENGLISH)

PARENTAL CONSENT FORM (CHINESE)

 

Student Health Services
  • 421 S. Campus Ave
    Oxford, Ohio 45056
    Phone: (513) 529-3000
    Fax: (513) 529-1892
  • Hours of Operation:
    8 am - 6 pm
    Monday - Friday
  • Map of Student Health Services

 

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