Forms
New/Incoming Student Forms
Internal Medicine
Health Information Management Forms
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Release of Health Information Form - for information going to a third party
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Request Access to Protected Health Information - access of your own information
Claims Form
- Pharmacy Claim Form - Electronically submit your claim for reimbursement of outside pharmacy expenses, you will need your member ID number and the Yale Health RxBIN#017449; or mail the paper Pharmacy Claim Form.
Student Forms
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Authorization to Treat MinorsStudent Allergy Medical Treatment Plan