General MIT Health Forms and Documents
Health history forms
Medical record forms
- Authorization for Release of Protected Health Information (Medical Record) to MIT Health
- Authorization for Release of Protected Health Information
(Medical Record) by MIT Health - Authorization for Release of Protected Health Information
(Dental Record) by MIT Health - Request for Amendment of Protected Health Information
Patient privacy / advocacy / rights
Student Medical Report forms
Pediatric care forms
- Consent for treatment of a minor (parental consent allowing another specific adult(s) to authorize medical care for a child in the parent's absence)
- Pediatric Health History
- Massachusetts certificate of immunization
- Massachusetts school health record form
- Massachusetts school immunization requirements
Wellness class registration
Class registration (Community Wellness at MIT Health)