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The Report of Medical History is for the student to self report (or parent to report if the student is under age 18) information regarding medical conditions, allergies, medications, and insurance coverage. Students must complete the Report of Medical History electronically by logging on to Online Student Health and selecting "Medical History" from the left hand menu.
This form is required and must be on file for any student under 18 years of age. A parent or guardian must sign and fax/mail the form to Student Health Service. Please be sure to include the student's name and ECU Banner ID number on the form.
This form should be used if a patient is requesting his/her Student Health records be sent to another medical office or other third party entity (insurance, law firm, job site, etc), or if requesting a release for SHS to discuss care with parents. Please fill in information completely and legibly. Allow 2-3 business days for records to be sent. There is no charge if records are directly sent to another facility from Student Health Service.