This form is for those providing health services for medical students.
When a situation is discovered where a student receives health services, including psychiatric/psychological services, by a provider who is also involved in the student’s academic assessment, it must be reported to the Associate Dean of Accreditation, Assessment and Evaluation. Please be mindful of confidentiality issues in completing this form.
Upon submission of this form, the information will be sent to the Associate Dean of Accreditation, Assessment and Evaluation. Make sure you are familiar with the Non-Involvement of Providers of Student Health Services in Assessment Policy