Medical Information and Other Forms

Medical Information Forms

• Disclosure of Medical Information
  • Authorization for Harvard University Health Services to release your medical records to the parties you specify.
• Release of Medical Information
  • Authorization for your health care provider to release your medical records to Harvard University Health Services.
• Student Vaccine Exemption
• Meningococcal Information & Waiver
• Information about Global Waivers at HUHS

Miscellaneous Health Forms

• Authorization to Disclose and Use Protected Health Information – Parental Consent for Minors
• Authorization to Treat a Minor
  • Parental consent for a minor to receive medical treatment from HUHS
• Consent to COVID Testing and Access to Information – Parental Consent for Minors
• Health Care Proxy/Advance Directive Form
  • Identify someone you know and trust to make health care decisions for you if you become unable to make those decisions.
• Living Will Wishes
  • Provide specific written instructions for your future medical care.
• Estimate for Procedure, Treatment, or Test
  • Request a written estimate for services provided by Harvard University Health Services.
• Missed Appointment Fee Appeal Form
  • Appeal a missed appointment fee from Harvard University Health Services.