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Forms

For Patients and Case Managers:  Authorization for Release of Medical Information

  • Authorization for Release of Medical Information Form

Forms for UVA Academic Employees

  • Travel Immunization Services Request Form
  • History of Positive PPD Assessment Form
  • Influenza Vaccination Declination Form

 Other Forms

  • Medical History Form for Non-Medical Employees
  • Medical History Form for Medical Employees
  • CDL Medical Exam Form
  • Bus Driver Physical Form
  • Respiratory Questionnaire / Patient Contact
  • Respiratory Questionnaire / Non-Patient Contact
  • Respiratory Fit Testing Educational Document
  • Respiratory Fit Testing FAQ
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Occupational Health

P.O. Box 800357

Charlottesville, Virginia 22908

Tel: 434.243.0075

Page maintained by: Jon Schuch

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