{"id":22,"date":"2006-09-11T08:55:30","date_gmt":"2006-09-11T13:55:30","guid":{"rendered":"https:\/\/www.nicholls.edu\/health\/forms-and-more-information\/"},"modified":"2026-04-10T18:05:32","modified_gmt":"2026-04-10T18:05:32","slug":"forms-and-more-information","status":"publish","type":"page","link":"https:\/\/www.nicholls.edu\/health\/forms-and-more-information\/","title":{"rendered":"Forms and More Information"},"content":{"rendered":"\t\t
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FORMS: (Adobe Reader<\/a> is required to view these documents)<\/span><\/p>\n

Acknowledgement of Receipt of Notice of Privacy Practices<\/a><\/p>\n

Authorization to Release Information in the Event of a Mental Health Crisis Form<\/a>
In compliance with Louisiana Act No. 157 (R.S. 17:3138.1), ÐÓ°É´«Ã½ gives all enrolled students the opportunity to complete a voluntary mental health privacy authorization form. This form allows students to identify trusted individuals with whom the university may share important health information if a mental health crisis arises. Our goal is to ensure students receive the support they need.<\/em>
<\/span><\/p>\n

Consent to Treatment<\/a><\/p>\n

COVID-19 Vaccine Exemption Form (<\/span>Electronic version<\/a>) <\/span>*For use by Nursing\/Allied Health students and faculty only!*<\/em><\/span><\/p>\n

Health History Form<\/a><\/p>\n

Immunization Compliance<\/a><\/p>\n

Immunization Waiver<\/a><\/p>\n

Incident Report<\/a><\/p>\n

Notice of Privacy Practices<\/a><\/p>\n

Release of Information Consent<\/a><\/p>\n

Student Physical Form<\/a><\/span><\/p>\n

TB Symptom Screen<\/a> *For use by Nursing\/Allied Health students and faculty only!*<\/em><\/p>\n

Telehealth Patient Consent Form<\/a><\/p>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t

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FORMS: (Adobe Reader is required to view these documents) Acknowledgement of Receipt of Notice of Privacy Practices Authorization to Release Information in the Event of a Mental Health Crisis FormIn compliance with Louisiana Act No. 157 (R.S. 17:3138.1), ÐÓ°É´«Ã½ gives all enrolled students the opportunity to complete a voluntary mental health privacy authorization form. […]<\/p>\n","protected":false},"author":6,"featured_media":0,"parent":0,"menu_order":17,"comment_status":"closed","ping_status":"closed","template":"","meta":{"site-sidebar-layout":"default","site-content-layout":"default","ast-site-content-layout":"default","site-content-style":"default","site-sidebar-style":"default","ast-global-header-display":"","ast-banner-title-visibility":"","ast-main-header-display":"","ast-hfb-above-header-display":"","ast-hfb-below-header-display":"","ast-hfb-mobile-header-display":"","site-post-title":"","ast-breadcrumbs-content":"","ast-featured-img":"","footer-sml-layout":"","ast-disable-related-posts":"","theme-transparent-header-meta":"default","adv-header-id-meta":"","stick-header-meta":"","header-above-stick-meta":"","header-main-stick-meta":"","header-below-stick-meta":"","astra-migrate-meta-layouts":"default","ast-page-background-enabled":"default","ast-page-background-meta":{"desktop":{"background-color":"","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""},"tablet":{"background-color":"","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""},"mobile":{"background-color":"","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""}},"ast-content-background-meta":{"desktop":{"background-color":"var(--ast-global-color-5)","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""},"tablet":{"background-color":"var(--ast-global-color-5)","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""},"mobile":{"background-color":"var(--ast-global-color-5)","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""}},"footnotes":""},"class_list":["post-22","page","type-page","status-publish","hentry"],"yoast_head":"\nForms and More Information - University Health Services<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/www.nicholls.edu\/health\/forms-and-more-information\/\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Forms and More Information - University Health Services\" \/>\n<meta property=\"og:description\" content=\"FORMS: (Adobe Reader is required to view these documents) Acknowledgement of Receipt of Notice of Privacy Practices Authorization to Release Information in the Event of a Mental Health Crisis FormIn compliance with Louisiana Act No. 157 (R.S. 17:3138.1), ÐÓ°É´«Ã½ gives all enrolled students the opportunity to complete a voluntary mental health privacy authorization form. 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