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.

Birth Control Order Form

  • Order Form to request refills of birth control pills.

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:

Informed Consent to Treatment and Privacy Practices

Informed Consent to Telehealth Services 

Information for students with ADHD

Communication Policy

Excuse Note Policy

Physicals Policy

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