PLEASE NOTE: As of May 2016, UF Health Compliance handles all University of Florida requirements regarding immunizations and health insurance. For more information and to complete the official UF forms, visit healthcompliance.shcc.ufl.edu.
Medical Forms
Before your first appointment
Minor Consent Form – Must be signed by Parent or Guardian if student is under 18 years old
New patients only: Get your insurance on file
New Patients Only – Private Insurance and Verification Form
We encourage you to provide us your insurance information ahead of time. The SHCC insurance team will contact you if there is an issue with the information provided.
Service-Specific Forms
Allergy Injection Clinic – New Patient Forms
Please contact us BEFORE transferring care for allergy injections. To avoid delays, please call the SHCC at 352-392-1161 to pre-register as a patient. When prompted, select option 1 (“Make an appointment”), then option 4 to connect with the allergy injection clinic.
Nutrition Services New Patient Questionnaire
X-ray Copies Instruction Form
Other Health Care Information
Advance Directives
For employees only:
Occupational Medicine
Find all forms required for your job duty here: UF Environmental Health and Safety (EH&S) Job Duty Listings and Occupational Medicine Program Forms. Please note: If the required forms are not complete, we cannot complete the health assessment, which in turn may delay the hiring process.
Medical & Immunization Records Request
- Complete the proper record request form
- For current students: SHCC Medical Release (ROI) Form for current students
- For non-students or former students: Records Release Form for non-students or former students
- Send record request form to SHCC:
- Fax: 352-392-5129 OR SHCC-MedRecordsFax@ad.ufl.edu,
- Hand-deliver OR mail your request to: UF Student Health Care Center, ATTN: Medical Records, P.O. Box 117500, 2140 Stadium Road, Gainesville, FL 32611.
- Requests turned into the SHCC by 2 p.m. Monday through Friday should be available for pickup after 4 p.m. on the same day. Requests for faxed or mailed records are handled as soon as possible.
PLEASE NOTE: Requests for copies of all or portions of medical records (including immunization records) must be in writing and signed by the patient. If you are not a currently enrolled UF student, payment must be arranged prior to records being mailed or faxed.
Charges
If applicable, please call Medical Records at (352) 273-4737 to arrange payment prior to records being mailed or faxed.
For copies which are authorized for pickup or mailing, there is no charge for the first 10 pages. There is a charge of $1 per page for next 25 pages, and 25 cents per page after the first 35 pages. There is a charge of $7 per hour for labor in obtaining copies of the records. Postage charges will be the total weight being mailed. We will also fax up to 2 pages at no charge.
Records more than 10 years old
Medical records of UF students are kept 10 years following enrollment inactivity or graduation. If a student returns to enroll at UF within that timeframe, their records are reactivated. After 10 years of inactivity, the medical records are shredded and burned in accordance with regulations.
Additional information
In accordance with the Health Insurance Portability and Accountability Act (HIPAA), the SHCC may not release information about medical care for any student 18 or over without express permission from the patient. (By law, medical records for patients 17 and under are available to parents/legal guardians.)
Should a patient 18 or over wish to release specific medical information to a third party, such as a parent or family member, they should inform their health care provider during or immediately after their visit. As each visit is treated individually, the patient must inform their health care provider of their wishes at each visit.
PLEASE NOTE: The “Release of Medical Records for General Purposes” form may NOT be used to request future medical/immunization records. Current UF SHCC patients may use this form to request copies of past medical or immunization records OR allow a third party verbal access to current diagnoses/treatments for specific conditions for a designated period of time.