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Privacy Notice
This document applies to how information and records regarding your health care at the UC Merced Student Health and Counseling and Psychological Services (SHS/CAPS) may be used and disclosed and how you can get access to this information.
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Privacy Notice
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Consent For Care Of Minor
Students under the age of 18 years old must have their parent/guardian(s) provide consent for general medical care.
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Minor Consent Form
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Immunizations
All undergraduate and graduate students are covered under UC Merced's Immunization Policy. UC Merced has adopted the recommendations of the California Department of Public Health (CDPH), the American College Health Association and the U.S. Centers for Disease Control.
Enter your immunizations online at myhealth.ucmerced.edu and send a copy of your immunization card into the Health Center for verification.
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Immunization Plan
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TB Medical Clearance Form
All incoming students must complete a TB risk screening questionnaire. Students identified as being at increased risk for tuberculosis will be sent a follow-up secured message through the myHealth portal detailing further instructions. (Higher risk includes travel to or living in South and Central America, Africa, Asia, Eastern Europe and the Middle East; prior positive TB testing; or exposure to someone with active TB disease.) These students must follow the instructions for tuberculosis testing and clearance, including obtaining their healthcare provider’s signature on the TB Medical Clearance Form attesting to the student being free of active tuberculosis disease. The signed TB Medical Clearance Form is submitted by following the Step by Step TB Clearance instructions for submitting TB and Immunization forms. This form should be submitted prior to the first day of classes. TB Screening must be current and within the last 12 months prior.
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TB Medical Clearance Form
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Immunization Exemption Policy
The University of California allows for exemptions to immunization requirements based on a medical condition, please follow the link for more information.
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Immunization Exemption Policy
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Immunization Medical Exemption Request Form
If you require a medical exemption from the UC Immunization Policy, please submit a request.
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Immunization Medical Exemption Request Form
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Medical Records Release
Records can only be released by, or to, the patient with a signed consent form. If you are under 18, your parent/guardian must be the one to sign this form.
We require at least ten (10) days advance notice to provide time to review the request, copy and prepare the medical record(s) for mailing, faxing or pick up.
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Medical Records Release Form
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Seasonal Flu Consent
Students, faculty and staff receiving a seasonal flu shot must complete this form prior to vaccination.
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Flu Vaccine Consent Form 2024-2025
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Confidential Communication Request
A confidential communication request is a request that communications be sent to the patient rather than policy holder at an alternate address or through an alternate mode of communication such as email.
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Confidential Communication Request Form
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Authorization for Release of Financial Information
This authorization is for the release of financial and insurance related information only. Release of medical records requires completion of a separate authorization.
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Authorization for Release of Financial Information Form
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Revocation Authorization for Release of Financial Information
Revocation of authorization for the release of financial and insurance related information only. Release of medical records requires completion of a separate authorization.
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Revocation Authorization for Release of Financial Information Form
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