Releasing Medical Records

If your home town physician or a medical specialist requests a copy of your Sindecuse Health Center medical record, you must sign an authorization before we can send it. Information from your medical record is NEVER shared with any area of the University, or with any administrator, faculty or staff member without your written consent.

Sindecuse Health Center has an Authorization for Use & Disclosure of Protected Health Information form which a student must sign and date. This form asks the student to identify the physician or medical office requesting the records. Seven to ten days notice is desired to allow time for copying and mailing. In addition, we recommend that the Health Center mail your record directly to your physician. Authorization forms may also be obtained from the health care provider requesting your records.

These signed authorizations should be mailed to:

Sindecuse Health Center - Medical Records Western Michigan University Kalamazoo, MI 49008-5445 or Fax to: (269) 387-4494 Attention: Medical Records

 

 

Adobe Acrobat Reader is required to view and print forms on this page.

 

Sindecuse Health Center
Western Michigan University
Kalamazoo MI 5445 USA
(269) 387-3287 | (269) 387-3204 Fax
shc-webmail@wmich.edu