Forms and Documentation

Information about forms and documentation for Student Health Services

Medical Records

Your Colgate medical record is confidential. The electronic record contains all the information you have provided to Colgate Student Health Services (SHS), plus documentation of any care you receive from us.  

University health records are maintained through a secure electronic health records (EHR) system and are completely separate from all other university records.  We will not release health information without your written permission, except in specific situations to protect you or others, or where required by law. Please refer to our Confidentiality and Patient Rights documentation for further details.  

Medical records can be requested within ten years after graduation.

If you believe it would be helpful for a medical provider at Student Health Services to speak with anyone regarding your health concerns or treatment, please discuss it with them. Together, the two of you can decide what information would be useful to share, including any limits or parameters on what specific information should or shouldn’t be released. Regardless, we will need written documentation of your specific preferences before information can be released.

Release of Information

If you would like Student Health Services to share your health record or any information regarding your care with another health care provider, or with a parent, partner, spouse, faculty member, or anyone else, federal law requires us to obtain your written permission. To have Student Health Services send or share information related to your care with others:  

Access your wellness portal and click on the three bars in the upper left corner, select optional forms, and then select and download the Release of Medical Information

  • Specify the information to be released
  • Identify the recipient’s name, address, phone, and fax numbers
  • Complete, sign, date, and upload the completed form in your wellness portal
Class and Medical Excuses

Colgate recognizes that students will occasionally have significant medical illnesses or injuries that prevent them from attending classes or completing assignments or exams. The student is responsible for contacting their professors and administrative dean concerning any make-up work, withdrawals, extensions, or incompletes that might be necessary.

With the student’s permission, student health services will verify prolonged absences with the student’s administrative dean. However, student health services will not notify professors and administrative deans about minor illnesses (that will resolve within a few days). Students will be expected to contact their professors directly about these brief days of missed classes and coursework.

For additional information, please see the Colgate University Student Handbook.

Medical Leave of Absence

When a student experiences significant physical or psychological challenges while enrolled as a student in a Colgate program, they may request to take a voluntary medical leave of absence through their administrative dean. 

For additional information, please see Colgate University’s Policy on Medical Leave of Absence.

RideAssist Non-Emergency Medical Transportation Assistance

Through a collaborative partnership between Student Health Services and Colgate’s Office of Campus Safety, temporary, on-campus medical transportation is available to students with appropriate and approved medical conditions.

Learn more about RideAssist

Download RideAssist request form/service agreement

Religious and Medical Exemptions

Students seeking a religious or medical exemption to required immunizations should complete the appropriate form on the following page:

Religious and Medical Exemptions - Complete and submit a request via mywellness.colgate.edu 

Confidentiality statement
  • Health and Wellness (H&W) and Sports Medicine (SM) staff (athletic trainers and physicians) maintain confidentiality in accordance with the ethical guidelines and legal requirements of their profession. Your health records are maintained in an Electronic Health Record (EHR) and are considered treatment records under FERPA. These records are completely separate from all other Colgate University records and your educational records. Health and Wellness staff may receive information from other offices on campus as part of their role as consultants on campus. Health and Wellness staff and SM staff will not share information about any patient outside of their care team without their written permission, except under the following circumstances:
    A patient presents as a serious danger to themself or another person;
  • A patient is under 18 years of age and discloses abuse or neglect to a clinical provider;
  • A patient discloses that a minor child, dependent adult, or elderly person is currently at risk for abuse or neglect;
  • A Colgate student seeks care at Community Memorial Hospital, another hospital, or an urgent care center, and that provider requests information, SHS will share relevant health information as needed for continuity of care.
  • A valid subpoena is issued on a patient's records, or a patient's records are otherwise subject to a court order or other legal process requiring disclosure;
  • As required by federal or New York State Public Health law.

 

Note for Division 1 Athletes receiving care through the Sports Medicine staff
This confidentiality applies to sports-related illness and injury only. If a student discloses information to a Sports Medicine staff member that is not specifically associated with a sports-related injury or illness, the Sports Medicine staff may be legally required to report this information (e.g., report of assault or sexual assault).

If any of the above exceptions are true, SHS staff will only disclose the necessary, relevant clinical information based on their profession's ethical guidelines and legal requirements. SHS staff will notify the patient appropriately of this disclosure as soon as possible.

Patient rights
  1. Be treated with respect, dignity and consideration without discrimination as to race, color, religion, sex, national origin, ability, sexual orientation, gender identity, gender expression, or veteran status.  
  2. Be treated with consideration, respect, and dignity, including privacy in treatment;
  3. Be informed of the services available at the center;
  4. Be informed of the provisions for off-hour emergency coverage;
  5. Be informed of your options for providers and request a change in provider understanding that this may require you to reschedule your appointment.
  6. Know the names, credentials, and positions of the staff working with you;
  7. Receive an estimate of the amount that you will be billed after services are rendered, and receive an itemized copy of your account statement upon request;
  8. Obtain from your provider or the provider's delegate complete and current information concerning your diagnosis, treatment (including possible side effects and risks), and prognosis in terms a patient can be reasonably expected to understand;
  9. Participate in your healthcare planning and consent by accepting all or part of treatments offered or refusing all or part of treatments
  10. Request a medical chaperone in the exam room if the exam may be of a sensitive nature.
  11. Receive information from your provider or the provider's delegate necessary to give informed consent before starting any nonemergency procedure or treatment.
    1. Informed consent shall include, as a minimum, the provision of information concerning the specific procedure or treatment, the reasonably foreseeable risks involved, and alternatives for care or treatment, if any, to allow the patient to make a knowledgeable decision;
  12. Refuse treatment to the extent permitted by law and to be fully informed of the medical consequences of that action;
  13. Refuse to participate in research if and when it is being conducted at the Health Center and/or through Sports Medicine;
  14. Voice grievances and recommend changes in policies and services to the Health Center without fear of reprisal;
  15. Express complaints about the care and services provided and have the center investigate such complaints.
  16. Privacy and confidentiality of all information and records pertaining to your treatment;
  17. Approve or refuse the release or disclosure of the contents of your medical record to any provider or the provider's delegate and/or healthcare facility except as required by law or third-party payment contract or necessary to safeguard you or the university community;
  18. Authorize or refuse family members and other adults who may have access to your confidential medical information;
  19. Have access to information about Advance Directives (https://www.health.ny.gov/community/advance_care_planning/ )
  20. Language translation services.
Patient responsibilities
  1. Provide the Student Health Center and/or Sports Medicine staff with accurate information about past immunizations, illnesses, injuries, hospitalizations, medications, including over-the-counter products and dietary supplements, and any allergies or sensitivities.
  2. Inform the Student Health Center and/or Sports Medicine staff of any changes in health status that could affect treatment.
  3. Follow the prescribed treatment plan, ask questions if you do not understand the directions or treatment given by a provider, discuss any desired changes in the treatment plan, and participate in your care.
  4. Notify your provider if the treatment plan no longer works for you.
  5. Inform your provider about any living will, medical power of attorney, or other directive that could affect your care.
  6. Treat those giving them care, as well as other patients, with dignity and respect.
  7. Accept personal financial responsibility for any charges not covered by your insurance.
  8. Keep appointments and arrive on time.
  9. Cancel appointments only when necessary and far enough in advance so that other patients might utilize that time.
  10. Be respectful of others' privacy and property while in the Health Center and/or Sports Medicine facilities.
  11. Not take actions that could harm themselves or others.
  12. Let the Health Center know about changes in contact information or insurance information.
  13. Report any adverse side effects of treatment and/or worsening of your condition.