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/^(((\d{2}([13579][26]|[2468][048]|04|08)|(1600|2[048]00))([-\/])02(\6)29)|(\d{4}([-\/])((0[1-9]|1[012])(\9)(0[1-9]|1\d|2[0-8])|((0[13-9]|1[012])(\9)(29|30))|((0[13578]|1[02])(\9)31))))$/

/^(((\d{2}([13579][26]|[2468][048]|04|08)|(1600|2[048]00))([-\/])02(\6)29)|(\d{4}([-\/])((0[1-9]|1[012])(\9)(0[1-9]|1\d|2[0-8])|((0[13-9]|1[012])(\9)(29|30))|((0[13578]|1[02])(\9)31)))) (\d|[0-1]\d|[2][0-3]):[0-5]\d$/

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Student Health and Wellness Client Information Sheet

Our office hours are 8am-5pm Monday-Friday.

If you are submitting Health Forms outside of these office hours, our staff will be unable to respond until our regular business hours. If this is an emergency, please call 911.

Please click here for after hours urgent care clinics, if needed for other services.

M-D-Y

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Asian American

Asian

Caucasian / White

Hispanic / Latino

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Multi-racial

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On campus

Off Campus

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Yes

Yes

Yes

Yes

M-D-Y

Yes

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M-D-Y

Yes

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M-D-Y

Fever greater than 100.4 F or chills

Cough

Shortness of breath

Sore throat

Fatigue

Unexplained muscle or body aches

Headache

New loss of taste or smell

Congestion or runny nose

Nausea or vomiting

Diarrhea

Henderson Student Health and Wellness is required by law to maintain the privacy of protected health information and to provide you with this notice of our duties and privacy practices with respect to protected health information. This notice describes how medical information about you may be used and disclosed and how you can access this information. Please review this document. You may request a copy of this notice. Other uses and disclosures will be made only with your written authorization.

We will use your health information for treatment. Information obtained by your healthcare provider is recorded in your chart to determine the course of treatment that will work best for you. Your healthcare team members record the actions they took and their observations.
We will use your health information for regular operations. We may use information from your health record to assess the care and outcomes in your case and others like it. This information is used in an effort to continually improve the effectiveness of the healthcare and the service that we provide.
We may contact you to provide appointment reminders, reminders of needed follow-up care, or missed appointments.
We may disclose to the FDA health information relative to adverse effects of food, medications, supplements, products, or product defects.
We may disclose health information to public health or legal authorities charged with preventing or controlling disease, injury, or disability, as required by law.
We may disclose health information for law enforcement purposes as required by law or in response to a valid subpoena.
We may disclose health information to the Vice Chancellor of Student Affairs, or the Director of Judicial Affairs in the Vice Chancellor's absence, if we feel that you pose a significant threat of danger or physical harm to yourself or to other members of the Henderson community.

You have the right to review the notice prior to signing the consent. Student Health and Wellness has the right to change their notices and practices. You may print a copy for your records.

You have the right to request restrictions as to how your health information may be used to carry out treatment or healthcare operations. Student Health and Wellness does not have to agree to the restrictions requested. The consent may be revoked in writing, except to the extent that Student Health and Wellness has already taken action in reliance thereon.

If you believe your privacy rights have been violated, you can file a complaint with the Director of Student Health and Wellness, the Vice Chancellor of Student Affairs, or with the Secretary of Health and Human Services.

EFFECTIVE: 8/21

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