#  Medical Information and Other Forms 

 



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##  Medical Information Forms 

 



  [### Authorization for Disclosure of Medical Information

 ](/sites/g/files/omnuum12951/files/2026-07/authorization_disclosure_medical_information.pdf) An Authorization for Disclosure of Medical Information is an authorization for Harvard University Health Services to release your medical records to the parties you specify. A Release of Medical Information is used to have your medical records sent to... 

 

 

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   [### Student Vaccine Exemption Form

 ](/sites/g/files/omnuum12951/files/2026-07/Student_Vaccine_Exemption_Form.pdf) 

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   [### Meningococcal Info Waiver

 ](/sites/g/files/omnuum12951/files/2026-07/meningococcal_info_waiver.pdf) 

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##  Miscellaneous Health Forms 

 



  [### Authorization to Disclose and Use Protected Health Information

 ](/sites/g/files/omnuum12951/files/2026-07/authorization_parental_consent_minors.pdf) 

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   [### Authorization to Treat a Minor

 ](/sites/g/files/omnuum12951/files/2026-07/authorization_treat_minor.pdf) Parental consent for a minor to receive medical treatment from HUHS. 

 

 

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   [### Consent to COVID Testing and Access to Information

 ](/sites/g/files/omnuum12951/files/2026-07/parental_consent_covid_testing.pdf) 

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   [### Missed Appointment Fee Appeal Form

 ](/sites/g/files/omnuum12951/files/2026-07/missed_appt_fee_appeal_form.pdf) Appeal a missed appointment fee from Harvard University Health Services. 

 

 

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   [### Advance Directive Forms – Health Care Proxy and Living Will

 ](https://www.honoringchoicesmass.com/multilingual-planning-documents/) Health Care Proxy: Identify someone you know and trust to make health care decisions for you if you become unable to make those decisions Living Will: Provide specific written instructions for your future medical care. 

 

 

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