Records, Forms, and Policies

Policies

• Confidentiality: NYU Student Health Center maintains a strict policy on confidentiality, in compliance with federal and New York State laws, to safeguard the privacy and security of your information. For additional information regarding uses and disclosure of your health information please see our Notice of Privacy Practices (PDF).
• Commitment to Inclusiveness: The Student Health Center is committed to providing quality care to all members of the NYU community who rely on our service. We recognize that race, ethnicity, gender, sexual orientation, religion, culture and socio-economic status may affect the health of an individual and/or influence an individual's healthcare choices. With that in mind, we strive to be sensitive to the diverse needs at NYU. Our commitment is to treat patients with respect, compassion, and sensitivity.
• Advance Directives
  
• Student Policy on Immunization
• Notice of Privacy Practices (PDF)
  
• Patient Rights and Responsibilities (PDF)
• Student Leave

Alcohol and Other Drugs:

• Substance Abuse and Alcoholic Beverages
• Student Conduct/Disciplinary Interventions Within the Wellness Paradigm

Sexual Assault:

• Reporting, Investigating, and Resolving Sexual Misconduct, Relationship Violence, and Stalking- Complaints Against Students
• Assault, Harassment and other forms of Sexual Misconduct Resources, Services and Programs
• Sexual Assault and Bias-Related Crime Prevention on Campus Overview
• Sexual Misconduct, Relationship Violence, and Stalking Policy
• Sexual Misconduct, Relationship Violence, and Stalking Resource Guide for Students

Smoking:

• University Smoke free Campus
  

Forms

All forms are in PDF format unless otherwise noted.

Financial Responsibility:

• Fees for Services Form

LiveWell NYU:

• PAWS Request Form
  

Immunization Records:

• Read about health requirements and for links to forms.

Medical Records:

• Authorization for Release of Health Information (PDF)
• Authorization for Release of Counseling Information (PDF)
• Authorization for Release of Medical Information and Confidential HIV-Related Information (PDF)
• Authorization for Treatment of a Minor (PDF)

Patient Accounts:

Application for Financial Assistance
Available for Full-time Graduate and Professional students only.

Student Health Insurance:

• Insurance Enrollment/Waiver (Student Health Insurance Enrollment/Waiver is an online process)
  

Health Records

Health Information Management Services
726 Broadway, 3rd Floor
New York, NY 10003-9580
Phone: (212) 443-1272
Fax: (212) 443-1002
Email: health.hims@nyu.edu

To Request a Copy of Your Health Record:

Your health records are maintained in compliance with both federal and New York State laws.

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 (HIMS) at the address above for inclusion in your confidential health record.*
*Please ensure that this information is identified with your name, date of birth, and student I.D. number.

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) form to the address above.

To Request a Copy of Your Health Record:
If you wish to obtain a copy of your health record, you must submit a written request to the HIMS Office. You may use the request form Authorization for Release of Health Information (PDF) for a printable copy. All information must be completed in order for your request to be processed.

PLEASE NOTE: If you are requesting copies of x-ray examinations, HIMS 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.

HIV/AIDS:

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). You may visit our department and complete the necessary forms on-site or you may fax or mail your completed request form to our department.

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 HIMS Correspondence Unit at (212) 443-1272.