Forms
Using the RAHS Health Center is easy! Find the registration form you need below, complete it, and mail or bring it with you to the health center at your school, or the school nearest you. Registration packets are also available at each of the RAHS health centers. Please call to schedule an appointment in advance.Pediatric Registration and Consent Forms
- Pediatric Registration and Consent Forms: Read the registration packet requirements and review the Notice of Privacy Practices. Print pages 3-7 and complete the forms. Mail or bring the completed packet to a RAHS health center.
- Pediatric Registration and Consent Forms – en Espanol: Lean la Carta de Bienvenida para cumplir con los requisitos de inscripcion y revisen los documentos de Notificacion sobre Politicas de Privacidad de UMHS. Impriman las pagina 4 a la 10, Ileneen los documentos.
- Pediatric Registration and Consent Forms – Arabic
- Pediatric General Consent for Healthcare – French: Lisez et examinez ce consentement général pour les services de santé et les informations importantes sur les patients. Imprimez et remplissez les formulaires et envoyez le dossier complété à votre centre de santé scolaire RAHS.
- Pediatric Registration and Consent Forms – Swahili: Soma na uhakiki Idhini hii ya Jumla kwa Huduma za Afya na Taarifa Muhimu za Mgonjwa. Chapisha na ujaze fomu na utume fomu zilizojazwa kwenye kituo chako cha afya cha shule cha RAHS.
Flu Immunization Forms
- RAHS Flu Vaccine Consent Packet and Flu Vaccine Information Statement : Print, read, and complete the Consent Packet. Please bring the completed forms with you to a RAHS flu clinic. There will also be blank forms at the flu clinic that you can fill out on site.
- Consent for Immunization Services- Child : Print, read, and complete the Consent for Immunization Services form. Please bring the completed forms with you to a RAHS flu clinic. There will also be blank forms at the flu clinic that you can fill out on site.
- Consent for Immunization Services- Adult : Print, read, and complete the Consent for Immunization Services form. Please bring the completed forms with you to a RAHS flu clinic. There will also be blank forms at the flu clinic that you can fill out on site.
- Consent- Inactivated Influenza Immunization And Immunization Record : Print, read, and complete the Immunization Services and Immunization Record form. Please bring the completed forms with you to a RAHS flu clinic. There will also be blank forms at the flu clinic that you can fill out on site.
Sports Physical Exam Clearance & Consent Forms
Print the two-page form. Complete and sign consent. Return the completed packet to a RAHS Health Center to schedule a sports physical appointment.
Adult Registration and Consent Forms
- Adult Registration and Consent Forms: Read the welcome letter for registration requirements and review the Notice of Privacy Practices. Print pages 3-7 and complete the forms. Mail or bring the completed packet to a RAHS health center.
- Adult Registration and Consent Forms – en Espanol: Lean la Carta de Bienvenida para cumplir con los requisitos de inscripcion y revisen los documentos de Notificacion sobre Politicas de Privacidad de UMHS. Impriman las pagina 4 a la 10, Ileneen los documentos.
- Adult Registration and Consent Forms – Arabic
- Adult General Consent for Healthcare – French: Lisez et examinez ce consentement général pour les services de santé et les informations importantes sur les patients. Imprimez et remplissez les formulaires et envoyez le dossier complété à votre centre de santé scolaire RAHS.
- Adult Registration and Consent Forms – Swahili: Soma na uhakiki Idhini hii ya Jumla kwa Huduma za Afya na Taarifa Muhimu za Mgonjwa. Chapisha na ujaze fomu na utume fomu zilizojazwa kwenye kituo chako cha afya cha shule cha RAHS.
Notice of Privacy Practices
- Notice of Privacy Practices - English: Confidentiality and security practices of UMHS and RAHS.
- Notice of Privacy Practices – En Español
- Notice of Privacy Practices – Arabic
- Notice of Privacy Practices – French
- Notice of Privacy Practices – Other available languages
Patient Rights and Responsibilities and After Hours Care
What you can expect from your school-based health center, as well as how to get help when the RAHS Health Centers are closed.
Additional Services for Minors
Please ask your health center about these services.
- Minor Consent for Confidential Services: Read and review the Notice of Privacy Practices (above). Read and review this Minor Consent for Confidential Services. Download and complete the form as directed by health center staff.
- Consentimiento de menores para servicios confidenciales: Lea y revise el Aviso de prácticas de privacidad (arriba). Lea y revise este Consentimiento de menores para servicios confidenciales. Descargue y complete el formulario según las indicaciones del personal del centro de salud.