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Release of Medical & Counseling Records

A written authorization from the patient is required in order for Student Health & Counseling (SHAC) to release medical information or copies of a patient's chart. The SHAC Release of Information form can be downloaded (see below), mailed, or faxed.

SHAC Release of Information Form (.pdf)

A patient may also send a letter to us with his/her full name, address, social security number, date of birth, phone number, signature, and the specific information requested. There may be a fee for the information released.

If mental health information is requested, additional information may be required. The information will be mailed to the address on the release form or letter of the request. Requests should be mailed to:

Medical Records Department
UNM Student Health & Counseling (SHAC)
MSC06 3870
1 University of New Mexico
Albuquerque NM 87131-0001

FAX: (505) 277-2020

For more information, call: (505) 277-3136

FAQs  |  General Information  |  SHAC Services