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Information and Consent Form -- for Students pdf - University - uhs wisc

Information and Consent Form -- for Students pdf - University - uhs wisc 2025

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The document is an Information and Consent Form from University Health Services (UHS) at the University of Wisconsin-Madison. It outlines the authorization for UHS to use and disclose a student's health information for treatment, billing, and healthcare operations while emphasizing confidentiality protections under FERPA and state law. The form also details payment responsibilities for services not covered by the Student Health Fee, consent for medical treatment, patient rights and responsibilities, and communication practices regarding health matters. Students must sign this form to receive care at UHS.

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