Release of Information
All Student Health medical records are considered highly confidential. Information contained in your chart can only be viewed by Student Health personnel unless you give written consent or pursuant to a lawfully issued subpoena under the authority of Section 355 of the Education Law.
Release of Information Forms:
- Authorization for Release of Medical Records (Outgoing Records)
This form authorizes SUNY Upstate Medical University Employee/Student Health Services to copy and release specified medical information to the name or facility listed by the requesting person. It must be completed by you in full and signed.
- Authorization for Release of Information to Upstate Medical University (Incoming Records)
This form authorizes the listed Primary Care Provider or facility to release specified information to SUNY Upstate Medical University Employee/Student Health.
An authorized signature is required on Release of Information request forms. Completed request forms can be returned in person to the Student Health Office during regular business hours, or by faxing to (315) 464-5471. Please allow up to 10 working days for a requested Release of Information to be completed. This service is provided free of charge. Contact our office at (315) 464-5470 if you have any questions.