Hall Health Center - University of Washington, Seattle : Download Forms

WHAT'S NEW

Seasonal Influenza Vaccine
Seasonal influenza vaccine is now available in the Immunization Clinic. Information about vaccine types, recommendations, and billing is provided. Last updated: 11/19/09
Health Advisory: MRSA Infections
Hall Health has seen an increase in the number of students coming in with MRSA infections. Read how to recognize, treat, and prevent MRSA.
UW Student Insurance Offers Free HPV Vaccinations
Free HPV vaccinations are available to female students, spouses, and domestic partners who are covered by the UW Accident and Sickness Insurance Plan.
Free Blood Pressure Screening for Faculty and Staff
Hall Health Center, Employee Health Clinic, Room 8 (lower level)
Bike Lights and Helmets (and more) Available in the WRC!
As a way of promoting safe exercise, SHAQ is selling high-quality bike helmets and light sets at bargain prices.
Smoking Cessation Program
Want to try a new method for quitting smoking?

SAF

Download Forms

Authorization Forms

Authorization form: from UW Medicine
Authorization for UW Medicine to disclose protected health information
Adobe PDF: 27k
Authorization form: patient information request
Patient request for access to protected health information
Adobe PDF: 24k
Authorization form: to UW Medicine
Authorization to disclose protected health information to UW Medicine
Adobe PDF: 25k

Consent Forms

Consent Forms
Care Agreement, Notice of Privacy Practices Acknowledgement, and Financial Agreement (last updated: 08/07)
Adobe PDF: 320k

Insurance Forms

Measles Immunity Verification Form

Measles Immunity Verification Form
How to provide proof of measles (rubeola) immunity
Adobe PDF: 20k

Pre-Registration Forms