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Forms
All of the forms listed on this page are PDF (Portable Document Format) files.
The Adobe Acrobat Reader is required in order to view and print these files. If you already have the Adobe Acrobat Reader, just click on the form and it will open the Acrobat Reader and allow you to print the
document. If you do not have the Adobe Acrobat Reader, simply download and install it. You can download the reader free of charge at:
http://www.adobe.com/prodindex/acrobat/readstep.html
Once installed, the reader will allow you to view and print these forms. You must complete the form, sign it, and return it to us.
Report of Medical History and Immunization Record
This is a two-page form used to record a brief medical history, record your
immunization history, and inform you regarding the disease meningitis and
the available vaccine.
Medical Records Release Form
- Student Health Services
This is a one-page form used to request a copy of your medical records. As we are required to ask your permission before releasing these records, this form must be completed, signed, and returned to us before the release of records can occur. Please include a check or money order for $10 US payable to TAMU with your form.
Student Health Services uses the
Report of Medical History
and Immunization Record to collect information
regarding immunizations. The form is intended for our internal use and it
should not be considered an official immunization record.
We will provide a copy of the form for informational purposes only, not as
an official record. The copy you receive will be designated as such in red
ink.
Similarly, we cannot certify other official records
that were submitted to us - a copy of a county health department record,
primary care physician's record, etc
We will release documentation of immunizations that were administered by
TAMU Student Health Services as an official record.
If you require immunization records for admission, immigration, or employment reasons,
we encourage you to acquire them directly from the source.
Health
History and Consent Form
This is a two-page form used to record a medical history, and authorize
treatment. If you are under 18 years of age, your legal guardian must sign
this form
Explanatory Statement for Absence from Class
For an injury or illness less than three days, a student may be
asked to complete the Explanatory Statement for Absence from Class form.
A faculty member and/or academic department can request confirmation of the
injury or illness by having students complete the Explanatory Statement for
Absence from Class
The student will initiate this process by completing the form either online or
manually. The form must be printed and signed. It is our understanding that
emailed or other electronic copies will not be accepted. Submission of the
form does not guarantee an excused absence. The choice to excuse or not excuse
the absence is left to the discretion of the faculty member or academic
department. The TAMU student rule can be found at
http://student-rules.tamu.edu/rule7.htm
EMS Medical Records Release Form
This is a one-page form used to request a copy of your medical records related
to services provided by our Emergency Medical Services unit. As we are required to ask your permission before releasing these records, this form must be completed, signed, and returned to us before the release of records can occur. Please include a check or money order for $10 US payable to TAMU with your form.
Prescription Transfer
Form
Please call the pharmacy at (979) 458-8292 to verify that we stock your
medication. Once you have confirmed that it is available, please complete
the form to the best of your ability. You may then either fax the form in
or bring the form to the pharmacy located on the first floor of the
Student Health Center. Please allow 48 hours for the processing of
transfers.
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