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Health Care Forms

Who do you want to recieve a copy of your medical records?

  1. Complete the Patient Request for Own PHI form.
  2. Fax, mail, or deliver the form to the Student Health Center.
  3. The Student Health Center will send the request to the provider that you designated in the form and will wait for the requested records to arrive
  1. Complete the Form BYU-I SHC to Provider Records Request form.(Be sure to include enough information about the health care provider needs to receive records from us.)
  2. Fax, mail, or deliver the form to the Student Health Center
  3. The Student Health Center will send the request to the provider that you designated in the form and will wait for the requested records to arrive.
  1. Complete the form Provider to BYU-I SHC Records Request form. Be sure to include enough information about the health care provider needs to receive records from us.
  2. Fax, mail, or deliver the form to the . Student Health Center.
  3. The Student Health Center will send the request to the provider that you designated in the form and will wait for the requested records to arrive.
  1. Complete the Authorization for Use and Disclosure of PHI form.
  2. Fax, mail, or deliver the form to the Student Health Center.
  3. If the form is filled out correctly, the records your designated will be provided to the person you authorized.

Do you need to waive the student health plan requirement?

  1. Complete the Waiver form
  2. Fax, mail, or deliver the form to the Student Health Center.
  3. The Student Health Center will process your request to waive the student health plan requirement upon receipt of the form.