Medical Records Line
The Student Health Center will release medical information when requested in the following manner:
- A Medical Records Release Form (e.g. see below) or letter must be completed and signed by the patient for whom the records are requested. We will not release records to someone other than the patient except when legally required or permitted to do so.
- The Medical Records Release Form or letter must comply with the following:
- Be accompanied by a photocopy of a current ID of the patient, with the exception of when the records are to be released to a third party facility or enterprise other than an individual (See number 3 below).
- Include the Patient’s Full Name, Social Security Number, and the years wherein care was received from the Student Health Center.
- Include the address to which the records should be forwarded.
- Include a current phone number whereby contact can be made with the patient.
- Be signed by the patient and attested to with the signature of a witness.
- If the records are to be released to a third party facility or enterprise other than an individual, then a specific name, contact number, and address/fax number of the receiving entity must be provided.
- When requesting only limited information from the records, the time period and items to be released (lab reports, exam form, etc.) must be listed. We will send only the information requested and not the entire chart, unless otherwise specified.
Mental Health records are handled separately from general health records. Therefore, the release of Mental Health Records, from our Mental Health Clinic, and general Medical Records from the Health Center will require separate request forms. Prior to submission, please verify that you are using the appropriate form for your circumstances.
Medical Release Forms
- General Medical Records Release Form – Records From Student Health to Other Entity
- General Medical Records Release Form – Records From Other Entity to Student Health
- Mental Health Records Release Form – Records From UTSHC Mental Health Clinic to Other Entity
- Mental Health Records Release Form – Records From Other Entity To UTSHC Mental Health Clinic
You may submit your request by one of the following methods:
- In person to a Medical Receptionist in the Medical Records Department at the Student Health Center,
- By mail to the:
Medical Records Department
University of Tennessee
Student Health Center
1800 Volunteer Blvd
Knoxville, TN 37996-3102
- By fax at 865-974-2632.