Forms / Policies
Student Wellness Services does not provide documentation for disability accommodations, emotional support animals, housing or dining exceptions. Practitioners are able to provide referrals to off-campus providers for neuropsychological assessment, psychoeducational evaluations, or other documentation needs. Student Wellness Services providers can consult with an assessor or off-campus provider (with a signed release of information) if the student has been in treatment or the provider has information to contribute to the evaluation and documentation process.
All visits to the Health Center are confidential.
Our staff maintains strict confidentiality with your medical records at all times. Medical records of all patients seen at the student health center are retained for 7 years after the last patient visit. Medical records are not transferred to micro fische.
Rights and Responsibilities
Each patient being seen and treated at the student health center is entitled to the following rights:
- To receive considerate and respectful care.
- To an explanation of the diagnosis, treatment and prognosis in understandable terms.
- To receive all necessary information to participate in decisions regarding your care.
- To refuse treatment and be informed of the consequences of making this decision.
- To privacy.
- To confidential treatment of disclosures and medical records and, except required by law, be afforded the opportunity to approve or refuse their release.
- To know the names and titles of people involved in your care and the right to change health care providers.
- To be informed of the possible changes related to your treatment
- To seek another medical opinion
- To file a grievance with the administration of the student health center if you feel any of these have been violated.
Patients must also assume responsibility for his or her own health care. This includes:
- Providing accurate information concerning your medical history.
- Asking questions if you do not understand the explanation of your diagnosis, treatment, or instructions given to you.
- Reporting changes in your health or adverse effects of treatment.
- Knowing your health care provider and acting in a respectful manner
- Keeping scheduled appointments and notifying the clinic of any cancellation or change of schedule.
- Maintain proper hygiene
- Following all rules and regulations that are posted in the Student Health Center.
- Keep the health center updated on any changes made in your health insurance and provide a copy of your insurance card.
- Agreement to Treatment
- NCAA Pre-Participation Exam Form (PDF)
- NCAA Pre-Participation History Form (PDF)
- Notice of Privacy Practices
- Release of Information and Records Consent Form (PDF)
- United Healthcare Prescription Drug Mail-In Order Form (PDF)
- United Healthcare Prescription Reimbursement Request Form (PDF)
- United Healthcare Medical Claim Form (PDF)
Student Health Services does not provide written letters for extensions related
to missing academic work due to illness. If the circumstance involves a
short time, 1-2 days, talk to your professor directly and explain the
circumstances. If you are unable to reach a reasonable understanding,
contact the Dean of Students by email and explain the situation and they can
assist you. If you have a significant or severe medical illness that
will affect your long term academic work, and need medical evaluation and
treatment, please make an appointment with Student Health Services. If
necessary, health information will be shared (with informed consent), to the Deans Office regarding your illness.
If you are looking for accommodations, please visit the Caltech Accessibility Services for Students website.