UHS Tang Center

Frequently Requested Forms

Topic	UHS Forms
Breastfeeding	Breastfeeding Support Program Registration Form (pdf)
Career counseling	Career Counseling for the General Public Information Form (pdf)
Computer workstation evaluation	Computer Workstation Assessment Form Format: (pdf, word doc , html)
Disability Management	Transitional Work Program - Supervisor's Tool Kit (Format: word doc, pdf)
Fees List	Updated fees list
Hepatitis B	Hepatitis B Statement Form (pdf)
Insurance	Waiver procedure (Now available online only) Waiver Reversal Request form (download current pdf) SHIP Enrollment Application for Students on Approved Leave or Filing Fee Status (pdf) Sample Fees for Student Services at Tang SHIP Authorization Handout (pdf) Non-SHIP Referral Tip Sheet (pdf)
Medical Records	Details on the Health Information Release Form for transferring medical records to or from UHS or requesting a personal copy
Medical Withdrawals	Everything You Want to Know About a Medical Withdrawal Notice of Withdrawal form Health Evaluation Form Request for Readmission Form Health Evaluation Form for Medical Clearance
SHIP Prescription Reimbursement Form	2010-11 SHIP members requiring reimbursement for prescriptions filled outside of UHS purchased during August 15 2010-August 14, 2011 can stop by the Student Health Insurance Office, Rm. 3200.
Travel Clinic appointment	Travel History Form (Format: html, pdf)
Workers' Compensation	Employer's Report of Incident (word doc) Personal Physician Pre-Designation Form (pdf) Volunteer Registration (pdf)