The Student Health Center will release medical information when requested in the following manner: 

1. A Medical Records Release Form (e.g. see below) or letter must be completed and signed by the patient for whom the records are requested. We will not release records to someone other than the patient except when legally required or permitted to do so. 
2. The Medical Records Release Form or letter must comply with the following: 
   • Be accompanied by a photocopy of a current ID of the patient, with the exception of when the records are to be released to a third-party facility or enterprise other than an individual (See number 3 below). Psychiatric records must be accompanied by two forms of ID.
   • Include the patient’s full name, Social Security Number or UT student ID number (for current students), and the years wherein care was received from the Student Health Center. 
   • Include the mailing address to where the records should be forwarded. 
   • Include a current phone number where the patient can be reached.
   • Be signed by the patient and attested by the signature of a witness. Psychiatric records must be signed by two witnesses.
3. If the records are to be released to a third-party facility or enterprise other than an individual, then a specific name, contact number, and mailing address or fax number of the receiving entity must be provided. 
4. When requesting only limited information from the records, the time period and items to be released (lab reports, exam form, etc.) must be listed. Unless otherwise specified, the Student Health Center will only send the information requested and not a patient’s entire chart or medical history.

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Medical Release Forms

Download the General Medical Records Release Form – Records From Student Health to Other Entity

Download the General Medical Records Release Form – Records From Other Entity to Student Health

Download the Psychiatric Medical Records Release Form – Records From Student Health to Student Counseling

Download the Psychiatric Medical Records Release Form – Records From Student Health to Other Entity

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Submitting Requests 

The following methods apply to records for clinic visits only. For mental health records, contact the Student Counseling Center or the Psychiatry Clinic directly. For security reasons, medical records cannot be sent via email.

You may submit your request by one of the following methods: 

1. By mail to the: 
   Medical Records Department 
   University of Tennessee 
   Student Health Center 
   1800 Volunteer Blvd 
   Knoxville, TN 37996-3102 
2. By fax at 865-974-2632. 
3. Online (for current students only with UT NetID access): Send an email with your student ID number requesting your records to [email protected] and your Student Health Center medical records (not including Student Counseling Center records) will be sent as a secure PDF attachment to your Student Health Patient Portal inbox within 1-2 business days. Psychiatric records may take up to thirty days.