Request for Release of Medical Records
Florida law requires that information contained in medical records be held in strict confidence and not be released without written authorization of the patient or legal representative. Information maintained in Student Health Services records that was obtained from other health-care providers may not be released by Student Health Services unless the patient gives written authorization for that release. The patient must give specific written authorization to release sensitive medical information.
This information may have been obtained from another health-care provider. Access to this information by health-care providers may be necessary for them to provide the patient with appropriate health-care. Sensitive medical information includes STD records; TB records; HIV/AIDS records; drug/alcohol treatment records; and psychiatric/psychological information. (Parents/guardians are not authorized to release the records of minors over age 12, who are tested for HIV/STD).
Student Health Services may not release family planning records of a minor to a parent/guardian without the consent of the minor, where the services were rendered without the parent/guardian's consent. The authorization the patient signs will remain in effect until the date specified on the form by the patient or when the patient requests in writing that the authorization be withdrawn, which the patient may do at anytime. The patient has a right to receive a copy of all parts of this authorization upon request.
Records may be requested by completing the UNF Student Medical Services Authorization for Use, Disclosure, and Release of Health Information form.
Medical Records Release Form
For immunization records ONLY requests, please use the following form. Please email your completed form along with a copy of a picture ID to email@example.com.
Immunization Records Release Form