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

You (the patient) OR your health care provider

  1. Complete the Request or Send Records form.
  2. Fax, mail, or deliver the form to the Student Health Center.
  3. The Student Health Center will process and act upon your request within 30 days.

Some One Else

  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.
Student Health Center Logo

Student Health Center

100 Student Health Center, Rexburg, ID 83460

208-496-9330 Phone

208-496-9333 Fax