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Directory
Departments
Clinicians
Appointments
Making Appointments
Using MyChart
Emergencies
Sign Up for MyChart
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
Hours
Directions and Parking
Contact
Our Story
Senior Leadership
Patient Partner Opportunities
We Hear You
Population Health Metrics
The Arts at Yale Health
Yale Health Patient Hardship Fund
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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)
Request Access to Protected Health Information (Japanese)
Request Access to Protected Health Information (Korean)
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Request Access to Protected Health Information (Spanish)
Claims Form
Pharmacy Claim Form
Supplemental Claim Form
Student Forms
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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
Notice of Privacy Practices
Insurance Information Update Form (COB)
