Forms, Catalogs, Handbooks and Schedules
(If you have difficulty accessing PDF files, please contact Student Affairs Office at: 315 464-4816.)
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Document(s) in the category of Student Health/Counseling. Number of document(s) found: 15
Note: i=interactive/fillable
Title
 | Description | Category
|
|---|---|---|
| Allergy History Screening Formi | Used to record allergy history. This form is to be completed by the student. | Student Health/Counseling |
| Authorization for Release of Medical Records | This form authorizes SUNY Upstate Medical University Employee/Student Health Service 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. | Student Health/Counseling |
| Authorization for Release of Medical Records to Upstate Medical University | This form authorizes the listed Primary Care Provider or facility to release specified information to SUNY Upstate Medical University Employee/Student Health. | Student Health/Counseling |
| Blood & Body Fluid Exposure Protocol | Blood & Body Fluid Exposure Protocol | Student Health/Counseling |
| Certificate of Health Statement | There are no exceptions, all students must complete this form | Student Health/Counseling |
| Meningoccal Fact Sheet | Basic facts about Meningoccal disease and vaccine | Student Health/Counseling |
| Meningococcal Vaccine Letteri | Meningococcal Vaccine information for students and parents | Student Health/Counseling |
| Meningococcal Vaccine Response Form | New York State Public Health Law requires that all college and university students enrolled for a least six (6) semester hours or the equivalent per semester, or at least four (4) semester hours per quarter, complete and return this form to SUNY Upstate Medical University Employee/Student Health. | Student Health/Counseling |
| New Students: Mandatory Health Clearance Forms | Instructions for the health forms that need to be completed to meet the requirements for registration. | Student Health/Counseling |
| Report of Medical Examination | Completion of this form requires a physical examination. All sections of this form are to be completed by your health care provider, with each item marked individually (no lines through will be accepted). The forms must be signed, dated and stamped by your health care provider and include address and phone number. | Student Health/Counseling |
| Student Authorization for Release of Medical Information | Student Authorization for Release of Medical Information | Student Health/Counseling |
| Student Health Form | To be completed by the student with each item being checked and an explanation for all "yes" answers in the space provided. You may use an additional sheet, if necessary. Your health care provider needs to complete the summary section, sign and date. | Student Health/Counseling |
| Student Health Insurance Packet | Student Health Insurance Packet | Student Health/Counseling |
| Student Immunization Form | All sections need to be completed by your health care provider. Laboratory testing for antibody titers is required and copies of the laboratory report must be returned with the form. Dates of immunization alone are not acceptable. | Student Health/Counseling |
| Women's Health Services & Contraceptive Counseling | Women's Health Services & Contraceptive Counseling | Student Health/Counseling |