Content | Navigation |

Medical Records and Release of Information

Student Health Portal

Currently enrolled students have access to the Student Health Portal, which may be an option for obtaining copies of some health records, including immunizations. To log in, students will use their NDSU electronic ID (same as Blackboard). When printing records through the Portal, a signed authorization form is NOT needed. 

Former students who are not currently enrolled, please see the next section of Requesting a Copy of Your Medical Records. 

Requesting a Copy of Your Medical Records

Students may request copies of their medical records for any services performed at Student Health Service. In order to obtain a copy of these records, the student must first fill out and sign the Authorization and Request for Release of Medical Information form. Once this form has been submitted, please allow 5-10 business days to process this request. If you have any questions on how to fill out this form, please contact 701-231-7331. The completed form can be sent to us any of the following ways:

  • Fax to 701-231-6132
  • Upload through the Student Health Portal
    (select the appropriate drop down option under the Upload tab that says "Release of Information")
  • Hand deliver or mail to:
    NDSU Student Health Service
    1707 Centennial Blvd
    NDSU Dept 2842; PO Box 6050
    Fargo, ND 58108-6050

We are unable to email records, so please be specific where you would like your records mailed to, faxed or you can also pick them up at our facility.

We are unable to re-release any records that have been sent to us from outside facilities. If you need to obtain copies of these records, please contact the facility the services were received at directly. 

Instructions to Complete the Release Form

Please follow these instructions for completing the Authorization to Release Medical Information form. If you have any questions, please contact Student Health Service (SHS) at 701-231-7331. 

The individual requesting information will fill in their information for the sections at the top of the form that asks for name, date of birth, student ID and telephone number

1. Please select the check box that is applicable for the request and fill in that individual or facility's information:

  • Release to means that the student is allowing us to release information to them self, another individual, or a facility (such as a hospital/clinic)
  • Receive from means that the student is allowing SHS to receive records from another individual or facility
  • Exchange with means that the student is allowing an exchange of information between SHS and the person and/or facility that is named under this section

2. Information to be released:
Be specific what type of information is being requested. If you want all information to be released, please select "All information".

3. Records from the time:
This section dictates the time range of the information that can be released. This document can be future dated for up to one year from the date it was signed. 

4. Purpose of Disclosure:
Select the appropriate reason for your request.

Items 5-9 provide information about how this form is used, so please read through these carefully. 

In order to be complete, the form must be signed and dated.

Special Authorization:
There are certain items that need special authorization before they can be released. If any of these topics apply to the information you are requesting, please make sure to select the item(s) and sign and date the form again. 


Student Focused. Land Grant. Research University.

Follow NDSU
  • Facebook
  • Twitter
  • RSS
  • Google Maps

 

North Dakota State University
Phone: +1 (701) 231-7331/ Fax: (701) 231-6132
Campus address: Wallman Wellness Center 102
Physical/delivery address: 18th Street and Centennial Blvd., Fargo, ND 58102
Mailing address: NDSU Dept. 2842 / PO Box 6050 / Fargo, ND 58108-6050
Site manager

Last Updated: Friday, July 27, 2018 1:53:09 PM
Privacy Statement