Please read this note to users sending or requesting forms with private health information (PHI) via email.

Policy Information Regarding:

• Medical Absence notes for missed classes/exams
• Prescriptions for ADHD medications
• Advanced directives and medical power of attorney

Medical Forms

• Allergy Desensitization Information and Forms
• Medical Absence Form (Self Verification)

Health Information Management (Medical Records)

• Instructions: Requesting medical records
• Authorization for Disclosure of Health Information
• Authorization – Verbal Communication with Healthcare Provider
• 3rd Party Consent to Treat a Minor (required for students under age 18)
• Self Sufficient Minor Status Verification
• Request for Addendum for Clinical Notes

Health Insurance/Billing Forms

• Medical Claim Forms (Aetna)
• Billing Dispute Form (Student Health)

Immunization Exemption Forms

• Medical Exemption for Immunization
• Religious Exemption for Immunization
• FLU: Medical Exemption Form
• FLU: Religious/Philosophical Objection Form
• FLU: Attestation for Employees
• COVID-19: Declination for Vaccination Form

USC Housing COVID-19 Exemption Forms

The forms below apply ONLY to students requesting exemptions to the COVID-19 vaccination requirement for USC Housing.

 

• COVID-19: Medical Exemption to requirement for USC Housing
• COVID-19 Religious Exemption to requirement for USC Housing

Dental Insurance Claim Form

• Delta Dental Claim Form

Studying Abroad Forms

• Medical Claim Form