Virginia Medical Records Release Form 1Virginia Medical Records Release Form 1
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University of Virginia Students and Alumni

Subject: Release of Medical Records
1. You must complete a Student Health “Consent for the Release of Medical
Information Form.” You can obtain one of these forms at Student Health.
2. Occasionally Student Health receives a signed statement from a student stating that he
wishes his medical information to be released to his parents. Student Health requires
students to use a standard consent form that complies with state and federal laws for
release of medical information. If you complete the Student Health Consent form and
return it to us, we will be happy to respond to requests from you or your parents to
provide them the applicable medical information contained in Student Health records at
the time the request is made.
3. Options:
a. Copy of Pre-Entrance Immunization Health Form (including any immunizations
on file). No Cost
b. Copies of Medical Records are free of charge if a Student Health provider refers a
student to an outside healt