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Making Appointments
Using MyChart
Emergencies
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After Hours
Language and Translation
Coverage
Student Coverage
Clerical & Technical, Service & Maintenance Coverage
Managerial & Professional Staff and Faculty Coverage
Yale Police Benevolent Association (YPBA) Coverage
Other Yale Benefits
Out of Area Coverage
Resources
Announcements
Classes and Events
Emmi Educational Videos
Forms
Healthcasts
Newsletter
Research Opportunities
University Wellness Resources
More
Health Topics
Coverage Topics
About
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Contact
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We Hear You
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New/Incoming Student Forms
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Internal Medicine
New Patient Questionnaire
Health Information Management Forms
Release of Health Information Form
- for information going to a third party
Request Access to Protected Health Information
- access of your own information
Designation of Patient Spokesperson
Designation of Contact Information
Connecticut Advance Directives Information and Forms
Request for Amendment to Medical Record
Student Mental Health & Counseling Records Release
Release of Health Information Form (Japanese)
Release of Health Information Form (Korean)
Release of Health Information Form (Mandarin)
Release of Health Information Form (Spanish)
Designation of Patient Spokesperson (Japanese)
Designation of Patient Spokesperson (Korean)
Designation of Patient Spokesperson (Mandarin)
Designation of Patient Spokesperson (Spanish)
Claims Form
Pharmacy Claim Form
Retiree Major Medical Claim Form
Supplemental Claim Form
Student Forms
Incoming student forms
Student Allergy Medical Treatment Plan
Student Revoke Waiver Form
Student Enrollment/Change Application Form (for dependents and affiliate plan)
Authorization to Treat Minors
Visiting Non-Degree Student Vaccination Record
Pediatric Forms
School/Sports/Camp State Health Form
Preschool/Daycare State Health Form
Authorization for the Administration of Medicine by School Personnel
Sports Pre-Participation History Form
Yale Health Inititial History Questionnaire
Other Forms
Pharmacy Mail Order Form
Notice of Privacy Practices
Insurance Information Update Form (COB)
