Release of Health Information

To maintain patient confidentiality and assure compliance with federal and state privacy laws, health information may not be released without a patient’s written authorization (except as permitted by law). The information below describes the process of requesting your health records at UC Davis Student Health and Counseling Services (SHCS). To request your health records, you will need to download and submit an Authorization For Release of Health Information Form (PDF). Signed and completed authorization forms may be submitted in person, by fax, or by mail:

• In Person
  Drop off the form at the Health Records location on the third floor of the UC Davis Student Health & Wellness Center
• By Email
  records@shcs.ucdavis.edu
• By Fax
  (530) 752-5587
• By Mail
  Student Health and Counseling Services
  ATTN: Release of Health Information Department
  University of California
  One Shields Avenue
  Davis, CA 95616-8711

Please note:

• Records involving HIV/AIDS test results, drug and alcohol abuse, diagnosis, or treatment, or genetic testing information can only be released with a specific request from you.
• Counseling and psychiatry records may require longer process time since they must be reviewed by a mental health provider before being released.
• Records beyond 10 years of last visit encounter may not be available.
• SHCS requires that requests for health information specify the type(s) of health information and treatment date(s). SHCS does not accept uninformed consent requests for “All” future records.

Student Health and Wellness Center

The UC Davis Student Health & Wellness Center utilizes the newest technology and the latest trends in student healthcare to enhance student visits and delivery of care.

Ways a parent can stay in touch with their student’s healthcare:

• Patient can authorize the provider to call parent during a medical visit.
• Patient can submit an Authorization for Release of Health Information form for copies of health records to be sent to parent.
• Patient can submit an Authorization for Release of Health Information form authorizing verbal communication between provider and parent about a particular health issue.

Immunization Records for Yourself, or an Outside Provider or Facility

This section applies if you are requesting only immunization records.

If you are a current student you can view and print those immunizations received at SHCS via Health-e-Messaging on this website. Both former and current students can also come to the information desk at Student Health and Wellness Center with a current photo ID to request a free copy of all immunizations currently included in your health record. This includes lab titers and positive Tuberculosis Test (Quantiferon lab or PPD skin test) chest x-ray reports.

If you are requesting immunizations to be sent to an outside provider or you are out of the area:

• Signed and completed Authorization Form (PDF) is required.
• No fees charged to process request.
• Up to 15 calendar days to process request.

Health Records for Personal Use

• Signed and completed Authorization Form (PDF) is required.
• Copies on a CD or paper can be requested. The fees are as follows:
  CD: $5.00 flat processing fee.
  Paper: $5.00 processing fee plus an additional $0.15 per page copied and a shipment fee of $5.75 for certified mail.
• To avoid the shipment fee, patients can request to pick up paper copies of their health records at the Student Health and Wellness Center.
• Fees for current students are billed directly to their Banner student account
• For non-students, payment must be made via check or money order made to “UC Regents”.
• Processing time can be up to 15 calendar days

Health Records to an Outside Provider or Facility

• Signed and completed Authorization Form (PDF) is required.
• No fees charged to process request.
• Processing time can be up to 15 calendar days.

For More Information or Assistance

If you have questions or need help with your release request you can visit the SHCS Release of Health Information Department located at the UC Davis Student Health & Wellness Center or call (530) 752-2349 and select Health Records/Release of Information.