Immunization History & Health Records
Request a Copy of Your Health Record
Your health records are maintained in compliance with both federal and New York State laws.
If you wish to obtain a copy of your health record, you must submit a written request to Health Information Management Services. You may use the request form Authorization for Release of Health Information (PDF 676 KB) for a printable copy. All information must be completed in order for your request to be processed.
Note: If you are requesting copies of x-ray examinations, Health Informatoin Management Services can provide you with copies of written results of your x-rays. if you need copies of your radiology films, you must contact Radiology Services directly at (212) 443-1072.
If you are under 18 years of age
For students under 18 years of age, a parental or legal guardian authorization for medical treatment form must be on file in our office in order for you to receive prompt care and treatment, should the need arise. Please complete and return the Authorization for Treatment of a Minor (PDF 86.3 KB) form to Health Information Management Services.
If you are a new patient and have an on-going medical condition
(e.g. diabetes, epilepsy, heart disease, allergies, etc.)
It is important that we have a summary of your medical history to provide you with the best possible care. You may send the information to Health Information Management Services for inclusion in your confidential health record.*
*Please ensure that this information is identified with your name, date of birth, and student ID number.
If your health records contain information relating to HIV or AIDS, the New York State Department of Health requires a special authorization form - Authorization for Release of Confidential HIV Related Information (PDF 1.8 MB).
You may visit our department and complete the necessary forms on-site at the Student Health Center or you may fax or mail your completed request form to Heath Information Management Services.
Fees for Copies of Health Records
Health records will be sent to another healthcare provider free of charge as a professional courtesy. However, records not going directly to another healthcare provider are copied at the rate of 75 cents per page. Health records will be released upon payment of all fees. If you have any questions regarding the release of your health records, please contact the Health Information Management Services Correspondence Unit at (212) 443-1272.