Medical Records & Forms

Records & Forms

Do You Need To Request Medical Records or Immunization Records? 

Personal medical information and records are confidential, so a signed authorization form is required to receive a copy of your medical records. 

If you are a current student, faculty or staff, follow these directions to obtain a copy of your medical records:

     1. Go to the Patient Web Portal.

     2. Log in with your UARK credentials.

     3. Select the "Messages" tab on the left side navigation.

     4. Then select "New Message". 

     5. Select "Medical Records Request- release of information requests".

     6. Click "Continue." 

     7. Complete the form in its entirety.

Note: For Immunization Records, select the Immunization's tab. Viewing immunizations does not require a Release of Medical Records.

If you no longer have access to your web portal, follow these directons to obtain a copy of your medical records:

  1. Complete the Release of Medical Records Form (form can also be picked up at the health center). Note: All fields need must be filled in. Be sure to sign and date the bottom of the form.

  1. Email a completed authorization form and a copy of photo ID to: Buena Burks, Health Information Management Specialist.

Please allow up to 7-10 business days for processing.

Medical Records Charges: $10.00 (processing fee) plus $0.50 per page for first 25 pages ($0.25/page after). No charge for physicians/medical institutions.

Other Charges:

  • Verification of psychiatric disability: $50.00

  • Radiology images: $5.00

  • Additional microfilm retrieval fee of $10.00 (for any protected health information). 

Cash, Check, VISA, MasterCard, Discover and RazorBuck$ accepted. Checks payable to University of Arkansas.

Questions? If you have any questions or would like to follow up on the status of your record request, please contact the Health Information Management Specialist, Buena Burks, or call 479-575-4451 (option 1). 

Forms

Absence Explanation

Authorization for Treatment of Minor

Immunization Compliance

Physician Request for Lab Orders

Medical Services Charges Policy

CAPS Release of Confidential Information Authorization

Patient Rights & Responsibilities

Release of Medical Records (only use this form if you can't request it via your Patient Web Portal)

Class Excuse Policy

The Pat Walker Health Center does not provide class excuses.

Because of federal health care privacy regulations, we cannot release protected health information (including dates and times services performed). 

If an illness prevents a student from attending classes for an extended period of time, the Dean of Students will be notified with the student’s permission.

Students and faculty may find it useful to use the Absence from Class Form as a means to have appropriate communication about class absences.