Forms
Immunizations
- Immunization Documentation Form (optional - not required)
- Immunization Exemption Request Form
Insurance
Medical Records / Consent
- Authorization for Disclosure of Protected Health Information
This form is used to provide verbal disclosure to a patient's protected health information to another individual, such as a parent and/or guardian. - Authorization to Release Medical Information
This form is used for patients requesting their physical records be sent and/or shared with themselves, another individual or a facility. There may be a charge to have records copied. - Consent to Treat a Minor Child (Parent/Guardian Authorization)
Dietitian
Advance Directive
- Create a Health Care Directive
- Another good resource would be your state's Department of Health website
Class Excuse Documentation
- An email was sent out to the faculty listserv on 10/22/2021 stating that Student Health Service will not provide letters for work or class to students who are ill. A copy of that email can be found by clicking here. Please refer to NDSU's Policy Manual, specifically Section 333 - Class Attendance Policy and Procedure.