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
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)
- Dental: Find updated claims information through the Delta Dental patient portal.
- Medical Claim Form for study abroad programs
Immunization Exemption Forms
For measles, mumps, varicella, meningococcal disease vaccines
Influenza Forms
- FLU: Medical Exemption (Fillable Digital Fields)
- FLU: Religious/Philosophical Exemption (Fillable Digital FIelds)
- FLU: Attestation (for Employees)
USC COVID-19 Exemption Forms
See the University of Southern California COVID-19 vaccination policy. The forms listed in this section may be completed and uploaded for review to MySHR.
- COVID-19: Medical Exemption to requirement (for Students)
- COVID-19: Medical Exemption to requirement (for Faculty and Staff)
- COVID-19: Religious Exemption to requirement
- Solicitud de exención religiosa para la vacunación de COVID-19
- Solicitud de exención médica para la vacunación de COVID-19
- Scarcity Exemption Form (for individuals outside of the U.S.)
- 90 Day Self Attestation Form