This page contains many of the documents and forms required to release information, request immunization records, return from medical leave of absence, and so forth.

Forms:

Release of Information Form

  • An authorization to release medical or mental health records.

Minor Consent to Treatment Form

  • An authorization from parent or legal guardian allowing SHAC to treat students under 18 years of age.

Immunization Record Request Form

  • To request immunization records be released to a 3rd party or to the student after graduation. Student health records are retained for 8 years after graduation.

Conscientious or Religious Exemption Form

  • For use if unable to meet required immunizations due to conscientious or religious belief.

Mental Health – Medical Leave of Absence Return Questions 

  • A form used for an off-campus mental health provider (therapist, psychiatrist) to relay mental health information regarding a student’s ability to return to Carleton from a Medical Leave of Absence.

Physical Health-Medical Leave of Absence Return Questions

  • A form used for an off-campus physician to relay physical health information regarding a student’s ability to return to Carleton from a Medical Leave of Absence.

Policies:

SHAC does not store personal medications for students. We suggest purchasing a refrigerator or lock box to use in your dorm room.