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Record Release Forms

Release of records

Email a request for medical records to StudentHealthService@wusm.wustl.edu

Individual Authorization for WashU Student Health

Third Party Authorization for WashU Student Health

HIPAA Medical Record Request

MO AUTHORIZED RELATIVE CERTIFICATION – WUSM Student Health (002)

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Office of Student Health Service

WashU Medicine

Mailing Address: 660 S. Euclid Ave., CB 8030

Office Location: 4525 Scott Ave., Room 3420 (Third Floor), East Building

St. Louis, MO 63110

Phone: (314) 362-3523

Fax: (314) 362-0058

Studenthealthservice@wusm.wustl.edu

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