|
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 your immunization history, and
inform you regarding the disease meningitis and the available vaccine. You
may have received a copy of this form when you were admitted to TAMU.
Medical Records Release Form
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.
Consent to Treat and Health History Form
This is a two-page form used to authorize treatment and record your health
history. To authorize treatment for students that are under age 18, this
form should be completed then signed by a legal guardian. Students under
age 18 must have this form when they present for care.
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
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.
|
