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:
There are 3 different types of Release of Information (ROI)
- Release of information to allow Student Health to share information with other required clinical sites during the course of the student’s education at Upstate. Limited information shared includes immunization status and/or titers, results of TB screening tests, and dates of annual health assessment and mask-fit testing, if required. Completion of this ROI is required for all matriculated students and is usually done prior to starting classes at Upstate. This form can be accessed by our health portal at https://eshportal.upstate.edu. To log on, simply type in your Upstate username and password and click on Forms and chose ROI to download and complete form to submit to Student Health.
- 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.