{"id":4916,"date":"2017-08-15T21:38:47","date_gmt":"2017-08-15T21:38:47","guid":{"rendered":"http:\/\/bferrign.wdev.rochester.edu\/uhs\/?page_id=4916"},"modified":"2026-02-10T14:42:29","modified_gmt":"2026-02-10T19:42:29","slug":"forms-and-policies","status":"publish","type":"page","link":"https:\/\/www.rochester.edu\/uhs\/primary-care\/forms-and-policies\/","title":{"rendered":"Policies and forms"},"content":{"rendered":"

Policies<\/h2>\n

Addressing Patient Concerns<\/a><\/p>\n

Amend Protected Health Information<\/a><\/p>\n

Confidentiality and Patient Rights\u00a0<\/a><\/p>\n

Evaluation and Treatment for ADHD<\/a><\/p>\n

Health Requirements for Entering Students<\/a><\/p>\n

Immunization\u00a0& Medical Record Requests<\/a><\/p>\n

Notice of Privacy Practices – English<\/a><\/p>\n

Notice of Privacy Practices – Espanol<\/a><\/p>\n

Sensitive Exam Policy<\/a><\/p>\n

Telemedicine Services<\/a><\/p>\n

Forms<\/h2>\n

Application Form for Domestic Partners<\/a><\/p>\n

Controlled Medication Agreement<\/a><\/p>\n

Health Requirements for Entering Students<\/a><\/p>\n

Hepatitis B Vaccine Declination Form<\/strong><\/a><\/p>\n

Health Profession Student Flu Declination Form<\/a><\/p>\n

Influenza (Flu) High Dose Vaccine Consent Form 2023<\/a><\/p>\n

Influenza (Flu) Vaccine Consent Form 2023<\/a><\/p>\n

Influenza (Flu) Vaccine Declination Form 2026<\/a><\/p>\n

Influenza (Flu) Vaccine 2021-22 Flu Vaccine Information Statement (VIS)<\/a><\/p>\n

NYS Health Care Proxy<\/a><\/p>\n

Permission to Treat – Under 18<\/a><\/p>\n

Preventive Care Physical, ESTABLISHED Patient<\/a><\/p>\n

Preventive Care Physical, INITIAL Patient<\/a><\/p>\n

Rabies Vaccine Declination Form<\/a><\/p>\n

Respirator Education Information<\/a><\/p>\n

Respirator Medical Evaluation Questionnaire<\/a><\/p>\n

Request for Amendment\/Correction of Protected Health Information<\/a><\/p>\n

Request for temporary or permanent closer-in parking or student disability transportation<\/a><\/p>\n

Smallpox Vaccine Declination Form<\/a><\/p>\n

Telemedicine Consent Form<\/a><\/p>\n","protected":false},"excerpt":{"rendered":"

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