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Authorization to Release Health Record

New York State Law requires medical records to be kept on file for six years after a student graduates or departs from an educational institution. All medical records are destroyed after six years.

Student's immunization records have been electronically maintained and may be released when an Authorization to Release Health Record is completed and signed by a former student. If paying by check or money order, click on the above link to print form. Please complete and sign the form, and mail it with payment to the Health Center.

If authorizing and paying by credit or debit card online, please click the following link to complete and submit the ON-LINE Authorization to Release Health Record.


There is $5.00 processing fee. After reception of payment, the requested immunizations record will be released to the designated recipient.

The process may take up to a week before the designated recipient receives the immunizations record.