The Student Health Service Application and Forms

All domestic and international students and scholars who are in the Medical, Dental, Optometry, Nursing, EMS, and all “Clinical” School of Health Professions students need to fill this form out. Basically if you are going to be working with human or primate tissues or patients you need to complete this medical requirement.

All non-clinical international students and scholars need to fill out this form. Any domestic students in the following programs also need to fill out this form: Public Health, Joint Health Science Programs and those students in the School of Health Professions: Health Administration, Health Information Management, Health Informatics and Health Sciences. Please double check with your program to see if you will be regarded as a clinical or non-clinical student. Basically, if you will work with humane or primate patients or tissues then you are considered as a clinical student and you would need to fill out the “Clinical Health History Form”.

Patient medical charts are only kept up to 10 years from their last office visit. School Health Forms and any out of office immunization or medical records are only kept for 5 years if you never arrived at Student Health Services to be seen as a patient. Students have been instructed during their initial application process to always keep a home health file of their health forms and immunization data because we will not store these records indefinitely. Medical charts that have been inactive for over 12 months are moved to our archive storage and may require archive retrieval fees for any photocopy requests. Students requesting their medical & immunization records will be charged $1.00 per page for the first 25 pages and $.50 for each additional page copied with a $5.00 minimum fee. Additional $5.00 postage and handling fees for any records mailed and $10.00 archival research fees for inactive medical files. Additionally, students requiring an immunization form to be filled out or a residency or letter of good health to be processed will have to pay $10.00 for this service per individual request excluding any additional photocopy and postage or facsimile fees. Rush orders will also include an additional $10.00 fee and should be processed within 48 business hours {excluding holidays}. We will only fax immunization records. All other records will have to be picked up here in our office or mailed. Records not picked up will maybe mailed to your home address with an invoice or destroyed after 30 days from your request date. Unpaid medical records fees may result in a UAB hold on your student account. After filling out this request form you may fax us this request by dialing (205) 996-7468 or (205) 975-6193. These requests will be processed within 2-3 weeks and may take an additional 5 days for any archival research request. Students requesting us to look for old records will still be billed for the archive research fee regardless if we can locate old medical records or not. Call our Medical Records voice line at (205) 996-2589 for additional information.

If you are a clinical student or scholar your form should have this physical examination section on your form, this extra copy is here for students who need an additional physical exam sheet.