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We respect your right to privacy and confidentiality.

No information will be released without your written consent.

Click above to access the resource guide.

Health Record

The University Health Center requires a complete health record form on file, prior to your enrollment at JMU.

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 2012 Health Record Form must be completed by you and your physician and returned to the University Health Center. If your form is not received by July 1st for the fall semester and December 16th  for the spring semester, you will be subject to a registration hold placed on your account.

Students with incomplete health records requesting to be seen at UHC will be seen; however, a $25.00 non compliance fee will be administered until the health record is complete.  Any other applicable fees will also apply.

THE HEALTH RECORD IS DUE :

 JULY 1 - For Incoming Fall Semester Students Starting in August

 DECEMBER 16- For Incoming Spring Semester Students Starting the following January

  *It may take up to 48 hours after we receive your paperwork to enter it into our system*

Immunizations

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.

We are providing immunization forms in different languages, these can be found on our Forms page. We have provided these for the languages we deal with the most here at the Health Center. If you find any erros on the immunization forms please let us know by sending us an email at healthrecord.jmu.edu. 

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 (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.

Attention Seniors

The University Health Center recommends you request a copy of your immunization record prior to graduation. This is an important document to have for future records.

Please complete the *Health Information Release (.pdf format) and submit it by mailing or faxing the form to:

Fax # 540.568.6176.

Your request will be processed within 7 business days of receiving the completed form.

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Getting a copy of your health record

If you request a copy of your entire Health Information chart (previously called your 'medical record') there will be a $10.00 fee for the copy. Payment can be by check (made payable to JMU) or in person using a credit card (**MasterCard or Visa) or JAC card (Flex). 

• Fill out a *Health Information Request form (PDF)AND
• Fill out the*Health Information receipt form(PDF)

Mail the forms to UHC or drop the forms off at the UHC Health Information Office (UHC Room #5A). After receipt of completed forms, your request will be processed within 7 business days. A receipt will accompany the requested documentation. FAXES AND EMAILS WILL NOT BE ACCEPTED.

**University policy requires that the name on the credit card used for payment must be the same as the person signing the credit card payment.

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2012 Health Record Due Dates:

The form must be completed by a physician and returned to the Health Center by July 1st for the fall semester and December 16th for the spring semester.

Send your completed 2012

Health Record form to:

James Madison University
University Health Center
Montpelier Hall MSC 7901
235  Cantrell Avenue
Harrisonburg, VA 22807
Attn: Health Information

DO NOT FAX THE COMPLETE HEALTH RECORD FORM.

Questions?

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.

How to get a copy of your health record from UHC

Attention Seniors

2012

Emergency contact information (log on to e-campus) due dates:

Student Health Insurance

Confidentiality Statement: Your health information is kept confidential at all times and is not associated with your academic record. Health information will not be released without written consent by the student. Health information is retained for a period of 10 years following graduation or your last year of enrollment.

Health Information Coordinator

Karen Kennedy
Phone: 540.568.6249

Health Information Fax:
540-568-6176

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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