Forms and Health Resources

Most Student Health and Wellness Center forms and applications can be found below.

Advance Directives

• PDF Document: Guide to Advance Directives (PDF)

Allergy forms

• PDF Document: Allergy Immunotherapy Consent form (PDF)

Blood Draw Protocol:

• PDF Document: Blood draw protocol (PDF)

Consent Forms

• PDF Document: Consent to Medical and Surgical Procedure (PDF)
• Parental Consent to Administer Vaccine to a Minor

Food Insecurity Resources at JHU

• Free Food Alert
• CHEW Texting Alert for relevant Health Information
• Food Pantry
• SNAP (DOSL case managers will assist students with applying)

Illness Note Policy

• PDF Document: Homewood Illness Notes Policy (PDF)
• PDF Document: Peabody Illness Note Policy (PDF)

Immunization Compliance

• PDF Document: Pre- Entrance Health Form (PDF) (eligible undergrad, graduate, visiting and special students)
• PDF Document: Post-Doctoral Health Form (PDF) (post-docs only)
• PDF Document: Influenza Vaccine Information Statement (PDF)
• CDC VIS – Vaccine Information Statements

Medical Leave of Absence

• Student Outreach and Support

Medical Records

• PDF Document: Authorization for Release of Health Information(PDF)

  (Please note that incoming students requesting parental release should come to the Student Health & Wellness Center to complete the form in person.)

Medical Orders for Life-Sustaining Treatment

• www.marylandmolst.org

Specialty Providers and Pharmacies

• PDF Document: Dental and Vision Providers (PDF)
• PDF Document: Local Pharmacies (PDF)

Additional Resources

• Condom Jay Request Form
• Go Ask Alice (Q&A at Columbia University)
• Journal Sleep

JHU Websites

• Center for Health, Education & Wellness (CHEW)
• CHEW’s campaign for Sleep, Eat & Exercise (SEE)
• Counseling Center
• Office of Institutional Equity
• Office of the Registrar
• Ralph S. O’Connor Recreation Center
• Residential Life

Other External Websites

• Agency for Healthcare Research and Quality