Two Clinic Locations:
LINDNER CLINIC | PHONE (West Campus): 513-556-2564
Medical Records Fax: 513-556-1337
HOLMES CLINIC | PHONE (East Campus): 513-584-4457
Medical Records Fax: 513-584-2222
Two Clinic Locations:
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Medical Forms
Health Insurance Portability and Accountability Act
Permission to Release Medical Information
Under Age 18
+PPD Survey for initial positive TB testing and annual +PPD surveillance
(VIS) Vaccine Information Statement for Influenza Vaccine 2010-2011
2010-11 Flu shot
2010-11 Flu Mist
Specialty Forms for Incoming Students
Initial Athletic Health Appraisal
Incoming International Student Health Form
Employee Occupational Health Forms
University of Cincinnati Initial Report on Occupational/Work-Related Injury or Illness
- This form currently works only with Internet Explorer on a PC
On-Line Form
1352a Initial Report on Work Related Injury or Illness
Download
Appendix D – Respirator Medical Evaluation
OHIO FROI
New Employee – Supervisor Checklist