Medical Records Request

As a current student, you can log into Student Health Portal to view and print your immunization history.

You must provide a written authorization to release medical records. Please note that electronic signatures cannot be accepted​.

• Please print, complete, sign, and return an Authorization to Release Medical Information Form by Fax, Mail or Email. Medical records will not be released from an email request.  
• If you are unable to access the Authorization to Release Medical Information Form, please provide the following information on a signed and dated statement: 
  • Your name, address, and date of birth  
  • Name and address of the provider/facility to which the information is going to be released
  • The type of information requested (e.g., chart notes, labs, immunization records) 

Requests are typically processed within 10 business days.

You must provide a written authorization to release medical records. Please note that electronic signatures cannot be accepted.

• Please print, complete, sign, and return an Authorization to Release Medical Information Form by Fax, Mail or Email. Medical records will not be released from an email request.  
• If you are unable to access the Authorization to Release Medical Information Form, please provide the following information on a signed and dated statement:
  • Your name, address, and date of birth  
  • Name and address of the provider/facility to which the information is going to be released
  • The type of information requested (e.g., chart notes, labs, immunization records) 
• Requests are processed upon receipt of payment and are typically available within 10 business days.

• All information contained within a patient’s medical record or accessed via a computerized system is maintained strictly confidential to protect the patient’s right to confidentiality in compliance with the City, State, and Federal Regulations, including HIPAA and FERPA. 
• Designated individuals requesting access to a student’s medical information must provide a written authorization form signed by the student clearly identifying the records to be released.
• Medical records will not be released from an email request. 
• A written authorization can be obtained by printing, completing, signing, and returning the Authorization to Release Medical Information Form by Fax, Mail or Email. The signature on the authorization form must be that of the patient or legal representative if the patient is deceased or of the legal guardian if the patient is a minor or has been declared incompetent. 
• Attorneys requesting access to medical records are required to have the patient or designee complete the NYSDOH approved Release of Protected Health Information form.