Forms and Documentation

Information about forms and documentation for Student Health Services

Your Colgate medical record is confidential. This 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 pages for further details.  

Medical records are kept for seven years after graduation and are then destroyed.

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 on 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:  

  • Complete and sign an Authorization for Release of Medical Information
  • Specify the information to be released
  • Identify the recipient’s name, address, phone, and fax numbers
  • Sign and submit the completed form to Student Health Services
    • In person
    • By fax: 315-228-6823
    • By email: studenthealth@colgate.edu
    • By mail:

      Student Health Services

      Colgate University

      Attention: Records Dept.

      150 Broad Street

      Hamilton, NY 13346, NY 13346

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 the 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, health services does 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 coursework.

Policy on 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. If approved by the administrative dean, the student will leave campus (or study group) immediately, be granted grades of “W” in all enrolled courses (even if the normal deadline for withdrawal without academic penalty has passed), and will be obligated to adhere to the readmission requirements outlined below if the student desires to return to Colgate.

For additional information, please see Colgate University’s Standards of Conduct and Non-Academic Policies

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

Learn more about RideAssist

Download RideAssist request form/service agreement

If you are seeking religious exemption to immunization, please fill out this form.

Having a detailed history of your past physical and emotional health will permit us to personalize your health care while you are under our care. Incoming students must have completed a physical exam within the past twelve months and have submitted a Medical History Form, completed and signed by your physician.

If you have a complex health history:

  • You may wish to arrange for a summary letter from your physician
  • We also encourage you to schedule an introductory appointment with one of our health care providers upon arriving at school and deliver the letter from your physician
  • See our listing of Wellness Partners for additional campus resources

 

All new students must submit an updated copy of their immunization records prior to the start of classes. Incoming Student Immunization Form (Required)

Medical care at Student Health Services is strictly confidential.

The privacy and confidentiality of your health record are protected by law. Colgate University’s health records are maintained through a secure electronic health records (EHR) system and are completely separate from all other University records. Student Health Services will not release any of your health information without your written permission, except in the following instances:

  • In the event of your treatment at Community Memorial Hospital or another hospital or urgent care center, the community provider and Student Health Services will share relevant health information as needed for continuity of care.
  • If, in our judgment, releasing information is necessary to protect you or others from a serious threat to health or safety.
  • If it is authorized or required by law.

Similarly, Student Health Services does not routinely share information about your care with parents, faculty, or deans without your permission. Health information will be discussed with parents and faculty only at your request and with your written permission.

If you have any concerns about the confidentiality of our services, please speak with one of your healthcare providers.

  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. Have all aspects of your care explained to you in understandable terms and any questions answered.
  3. Discuss treatment options and their effectiveness, possible risks and side effects.
  4. Participate in decisions about your care and to give your informed consent to any diagnostic procedure.
  5. Have access to resources for health education regarding wellness/self-care and prevention of illness.  
  6. Be assured of the confidential treatment of disclosures and records and to have the opportunity to approve or refuse the release of such information except when release of specific information is required by law or is necessary to safeguard you or the university community.
  7. Refuse any medical treatment or procedure and to be informed of the consequences of such a decision.
  8. Receive information and/or guidance for continuing care to maintain optimal health.
  9. Receive appropriate referrals to other providers and services.
  10. An explanation of any financial obligations or charges.
  11. Discuss concerns about the care you receive.  
  12. Review your medical record with a clinician.  
  13. Refuse to participate in any research project. 
  1. Understand and use these rights.
  2. Seek medical attention promptly.
  3. Provide accurate and complete information about your past health history, that of your family, current status, relevant personal habits, and any other information pertinent to the public health of the campus community.
  4. Inform your care provider of any changes in your health status that could affect your treatment.
  5. Assist health care providers to compile a complete medical record by authorizing the Student Health Services to obtain necessary medical information from appropriate sources.
  6. Ask questions and get clarification regarding your condition or any suggested treatment.
  7. Ask about anything you do not understand.
  8. Follow the prescribed treatment plan and discuss any desired changes.
  9. Be considerate of other patients and Student Health Services staff.  
  10. Treat Student Health Services’ staff with courtesy and respect.
  11. Be prompt for scheduled appointments.
  12. Cancel appointments if you are unable to keep them.
  13. Accept financial responsibility for any charges you have incurred.