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We respect your right to privacy and confidentiality.

No information will be released without your written consent.

Health Record

The Health Record provides necessary medical information for the purpose of treating an eligible student when they come to the University Health Center. The UHC 2008-2009 Health Record Form must be completed by you and your physician and returned to the University Health Center by June 2nd, 2008. This form is also available from The University Health Center (UHC) office during normal office hours.

In addition to the health record and evaluation forms, we have included detailed information sheets regarding immunizations, meningococcal infection and Hepatitis B. We are obligated to provide this information to you in accordance with Centers for Disease Control guidelines. It is general information that is very pertinent and deserves your full attention. Please read each section carefully.

The Code of Virginia (Section 23-7.5) requires all eligible students to provide documentation of their immunizations. Vaccines are available for a fee at UHC for enrolled students. However, vaccine administration prior to arriving on campus is encouraged, as UHC does not bill health insurance.

Religious Exemption
Any student who objects on the grounds that administration of immunizing agents conflicts with his religious tenets or practices shall be exempt from the immunization requirements unless an emergency or epidemic of disease has been declared by the Board of Health. An affidavit of religious exemption must be submitted on a *Certificate of Religious Exemption (PDF format)
(Form CRE-1) which may be obtained at any local health department, school division superintendent's office or local department of social services. This form must be notarized.

Send your completed 2008-2009 Health Record to the following address:

James Madison University
University Health Center
MSC 7901
251 E. Grace St.
Harrisonburg, VA 22807
Attn: Health Information

If you have any questions regarding this form, please call the University Health Center Health Information office at 540.568.6178 or contact them by email at: healthrecord@jmu.edu.

*2008-2009 Health Record Form (.pdf file)

NOTE: An asterisk before a link indicates an Adobe file in the .pdf format. The Adobe Acrobat Reader is available for free download by clicking on the link below:

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